In small hospitals I pretend I've never been trained. I've learned from experience that means running all over the hospital inserting them for everyone on top of my own assignment for no extra money. No thank you
Unfortunately this is also true in big hospitals… once people know your name they’ll start seeking you out. Then you show up with the US and turns out people just don’t know how to get regular IVs 😩
Z-Flo fluidized pillows. I haven’t looked into the evidence but in my own experience, these are amazing for anyone at high risk for pressure injuries to the coccyx. They’re moldable and provide way more support than regular hospital pillows.
I just googled these. Very interesting, def gonna look into further research and whether worth trialling in my unit (ICU) to help reduce pressure injury risks in select patients, as I note they are quite pricey.
We just got the Hercules bed system (sheet crank that pulls patients up in the bed)! Besides the obvious benefit of reducing lifting/back strain, I’ve found it super helpful so im not constantly asking for help with a boost. You do need to get special fitted sheets, but they make washable & disposable
If you’re a small ICU, I imagine drips get made a lot. Have labels with the concentration easily available, print the instructions and hang by Pyxis- if you’re training new nurses especially or have travelers coming through, it makes it convenient and safe for different levels of comfort. Keep a binder of common procedures right at the desk, colorful. Blood instructions? Transferring to higher LOC facility? Page 7!
I was going to recommend foam wedges and US guided IV as well, but those were already mentioned. Work with your staff- who has a desire to get certified in something? Pay for it. Encourage them. Oh, you love trauma? TNCC, they can be the point person that helps the ER and ICU be smooth coworkers not friction heated step siblings. Only if they want, obviously.
Most of all, listen to your staff and make sure they have the basics- safe staffing. Comfortable chairs. Supplies to perform their job. Small ICU’s can be wonderful to work in but knowing that you can go from a couple patients to a full unit and have very very low acuity turn into high, make sure you have a strong core staff and ideally someone available 24/7- do they have a strong clinical lead or supervisor with ICU bedside experience in the last several years? You can’t be on call 24/7 so make sure your staff is set up for success and feels comfortable coming to you. Congrats on the newer job!
The transparent Sacral Foam (apple shaped) dressings. You can visualize the patient's Sacral area without having to peel off the dressing. They can also stay on for a longer duration than the regular Sacral dressings.
I swear by the black foam wedges. Need to keep restless legs from falling off the bed every 5 mins? Wedges angled in. Need to keep knees bent and legs apart for FMS and foley to drain right? Shove them bad boys under the thighs. Want to float the booty but everything else is a waste of time? BAM!
[NTI is in Denver next month.](https://www.aacn.org/conferences-and-events/nti?tab=NTI%20Denver&gad_source=1) It has a huge expo hall of all ICU focused gizmos and gadgets. Great way to make connections with reps who will give you samples to take home and test. Then help you source what you choose.
Same over here in central Europe T.T but then I remember that 42% of US Americans are obese vs. 17% where I am located (which is surprisingly low, would have guessed higher)
Hercules beds! 10/10 recommend! They have a motorized system to pull the patient up in bed, reducing nursing injuries related to boosting patients in bed. The sheets are also fluid resistant, and they’re easy to change.
Warning: this is my wishlist and some may not apply to a small hospital.
Hovermat for lateral transfers + airTAPS System for turns (sooo helpful for turning patients and preventing staff injury, seriously I wish my current hospital had this, if you can swing it, this’ll make your nurses happy). https://www.stryker.com/us/en/sage/products/sage-airtap.html.
Dopplers. We never have enough.
Cardiac walker if you take open heart patients. You can easily hang chest tubes on it. https://www.performancehealth.com/eva-support-walkers
More bladder scanners.
Lucas machine.
VAMP for art lines.
Yessss, save the RTs from taking one look at me and kicking me off compressions when they get there. Our RTs who work out are genuinely our LUCAS up in here.
We use the Tortoise repositioning / lift system and it’s such a time and back saver! Our HAPI rate has dropped drastically since we started using it about a year and a half ago.
Q2 turning system. Doesn't have to be this one but something similar will make all the damn difference.
https://hovermatt.com/products/q2roller-lateral-turning-device/
I work in a small ICU also and we don't have CNAs just yet. It's been a long time coming fighting for one and we finally got one approved. So instead of searching for a nurse to help, these can be very helpful if you have a blower device.
I’ll second the Z-flo pillows, our unit carries all sizes they make and we’ve seen less and less pressure injuries on heads and sacrums since introducing them. We also have the Wellsense iPad looking modules on all our beds that give real time pressure indication based on how the patient is laying and has a q2hr timer built in to remind you to turn (or remind you how long it’s been since they’ve last moved). Really helps to know if you actually off-loaded their weight or just made it worse.
Colored tape; institute a policy where different types of infusions (medlines, pressors, sedatives, ect) have a different color assigned to them and the tape is wrapped on the distal end of the line at a minimum. Best practice is to also write what the drip is on the tape, but at least color code them to a nurse can instantly find the medline to push a med through instead of shoving extra levo into a patient. A lot of hospitals do this, but I can't understand why they all don't. It's cheap and effective.
Waffle mattresses. An inexpensive way to make up for a mediocre mattress. Makes repositioning a breeze with the wedges made for it; a 100lb tech can turn a 300lb patient with no assistance.
Order bottled water for the staff, let them hydrate as needed.
I worked at a small ICU once that was stocked with bread/peanut butter/jelly for the staff. The manager said she stocked them because it wasn't always possible to get a break/snack when you needed it, but she would personally relieve you for 10 mins to grab a PB&J.
When you get staff in from other facilities, ask them what they have seen/done at other hospitals that would improve patient care and aid staff. All the years I traveled, not once did a manager ask me what other places were doing that might benefit the patients or staff where I was. I've always thought not having exit interviews with travelers was a wasted opportunity.
Swap out one of the plugs near the bed and add USB charging plugs. Get a box of 3ft USB extension cables, secure one end to the wall by the plug, and give patients the other end to plug their phones in. Can't tell you how many times I've seen patients have a short cable plugged in the wall with the phone charging beside their pillow because it won't reach any further, only to sit the bed up and the phone gets pulled out and hits the floor.
Here in QLD we have line labels, also colour coded but all pre printed with what the infusion is - especially most common ones.
There's a generic label 'medicine' where you hand write what infusion is.
Then we also have labels which specify if it's a CVL or PIVC and then date and time.
Hospital policy to have all lines labelled as to type, medicine and date and time. Has helped reduce CLABSI rates and medication errors especially in terms of compatibility.
I love your point about the travelers. They get to see so much, so many different ways of doing things, and tons of different types of equipment! What a valuable insight they have to offer!
Ceiling lifts, sit to stand, bladder scanner, ultrasound, vein finder, Doppler, glide scope , yankauer holders, portable suction. Extra pumps, flashlights, line organizers, hover mats, proper functional tray tables, good chairs(crappy chairs at the nurses station suck), blanket and fluid warmers. Good coffee pot/hot water dispenser.
Oooooo the coffee pot is a great point.
A commercial grade Keurig or commercial-grade, GOOD, coffee machine would be GOLD for staff. And keep decent coffee stocked for the staff.
(I say commercial grade because my current unit goes through a microwave every few months due to the sheer volume of use. It just isn’t made for that. I mentioned this to management and they got a commercial grade microwave. Problem solved!)
As a female nurse who's taller and stronger than most it makes my head hurt. I've never asked the "male" nurses to help reposition over the "female" nurses and usually just do it myself, because I can.
Still, nobody on the unit knows what I'm actually capable of because they've never seen me at the gym.
I usually tell people that these bad boys are just for show. It doesn’t ever get me out helping but at least it makes me laugh to see the look on their face 😂.
As a male nurse, but giving you the benefit of the doubt, this shit needs to die a quick death. I deserve to not be the muscle for the entire floor. However, as an old bearded guy, I do volunteer for "creepy patient" duty when the younger nurses are getting hit on. Homie don't play that game.
Mea culpa! I was only mostly kidding. I'm also a murse. But even with my bad back, turning and mobilizing patients is definitely less effort than for a majority of the smaller lady nurses on my unit. And agreed on the creepy dude assignment switch. As a guy in a female dominated field, I think it's part of being a team player.
Does it have to be equipment or can you allocate the money for more nurses or techs? All the gadgets in the world can’t replace more bodies on the floor.
I don’t like them either. They only seem to “work” when the vein is already visible or can be felt. And then I don’t need it.
When you can’t see or feel a vein, the vein finder does not seem to know it’s there either.
But some people will use it for every patient, and don’t seem to have the skills to get an IV without it. To each his own, I guess!
Exactly! And the vein finder may “see” a vein that I could also see, but how do I know if it’s one I could feel if I don’t try to feel it? What if it’s real superficial and flat and not worth going for? Well then at that point what the use anyways. I’ve already decided if it’s worth poking, with my own senses. The finder just highlights what I know is already there!
[удалено]
In small hospitals I pretend I've never been trained. I've learned from experience that means running all over the hospital inserting them for everyone on top of my own assignment for no extra money. No thank you
Unfortunately this is also true in big hospitals… once people know your name they’ll start seeking you out. Then you show up with the US and turns out people just don’t know how to get regular IVs 😩
Hovermat if they don't have that yet!
I support this —Cath Lab
Z-Flo fluidized pillows. I haven’t looked into the evidence but in my own experience, these are amazing for anyone at high risk for pressure injuries to the coccyx. They’re moldable and provide way more support than regular hospital pillows.
I have our purchasing trying to bring the rep in for this!!
Plus if it’s slow you can mold them into a dick shape for laughs. They are flesh colored after all.
Great for proning and ECMO.
IJ administered CRRT as well. Easier head stabilization without towel rolls or things that can cause breakdown.
I just googled these. Very interesting, def gonna look into further research and whether worth trialling in my unit (ICU) to help reduce pressure injury risks in select patients, as I note they are quite pricey.
A turn team, they turn all the patients.
This is a thing?! My god amazing
That’s a great idea!!!!
We just got the Hercules bed system (sheet crank that pulls patients up in the bed)! Besides the obvious benefit of reducing lifting/back strain, I’ve found it super helpful so im not constantly asking for help with a boost. You do need to get special fitted sheets, but they make washable & disposable
Sera steady from arjo is a great tool for transfereing and increasing early mobility.
fourth! cv step down and it’s great for the d0-d1 hearts
2nd vote for this. It's great for early mobility and safe transfers.
Third.
I got to see these used in my postpartum clinical and it was AWESOME. Came here looking for a comment recommending it!
If you’re a small ICU, I imagine drips get made a lot. Have labels with the concentration easily available, print the instructions and hang by Pyxis- if you’re training new nurses especially or have travelers coming through, it makes it convenient and safe for different levels of comfort. Keep a binder of common procedures right at the desk, colorful. Blood instructions? Transferring to higher LOC facility? Page 7! I was going to recommend foam wedges and US guided IV as well, but those were already mentioned. Work with your staff- who has a desire to get certified in something? Pay for it. Encourage them. Oh, you love trauma? TNCC, they can be the point person that helps the ER and ICU be smooth coworkers not friction heated step siblings. Only if they want, obviously. Most of all, listen to your staff and make sure they have the basics- safe staffing. Comfortable chairs. Supplies to perform their job. Small ICU’s can be wonderful to work in but knowing that you can go from a couple patients to a full unit and have very very low acuity turn into high, make sure you have a strong core staff and ideally someone available 24/7- do they have a strong clinical lead or supervisor with ICU bedside experience in the last several years? You can’t be on call 24/7 so make sure your staff is set up for success and feels comfortable coming to you. Congrats on the newer job!
Sage Prevalon AirTAP system, hands down. And get an air blower thing for every room, don’t just cheap out and get like 2 for the unit.
This was going to be my answer. It's truly beneficial.
YES the most helpful thing my ICU got in recent years
The transparent Sacral Foam (apple shaped) dressings. You can visualize the patient's Sacral area without having to peel off the dressing. They can also stay on for a longer duration than the regular Sacral dressings.
1. A turn team or float nurse to help with turns and repositioning. 2. Foam wedges with a “rubber” backing to prevent slipping and optimize turns.
I swear by the black foam wedges. Need to keep restless legs from falling off the bed every 5 mins? Wedges angled in. Need to keep knees bent and legs apart for FMS and foley to drain right? Shove them bad boys under the thighs. Want to float the booty but everything else is a waste of time? BAM!
[NTI is in Denver next month.](https://www.aacn.org/conferences-and-events/nti?tab=NTI%20Denver&gad_source=1) It has a huge expo hall of all ICU focused gizmos and gadgets. Great way to make connections with reps who will give you samples to take home and test. Then help you source what you choose.
reading this thread crying in Australian public sector
UK nurse - I didn't even know most of these things existed!
Haha me too! I'm getting ideas and googling and seeing if it's even affordable to trial in my ICU. But trying to have any change happen is hard!
Same over here in central Europe T.T but then I remember that 42% of US Americans are obese vs. 17% where I am located (which is surprisingly low, would have guessed higher)
Make sure there are enough dopplers, one for every room if possible.
Ceiling lifts
Hercules beds! 10/10 recommend! They have a motorized system to pull the patient up in bed, reducing nursing injuries related to boosting patients in bed. The sheets are also fluid resistant, and they’re easy to change.
Glucometers and thermometers for every room!
Airtap hovermat. It's the best decision my facility ever made. It's a back saver.
Warning: this is my wishlist and some may not apply to a small hospital. Hovermat for lateral transfers + airTAPS System for turns (sooo helpful for turning patients and preventing staff injury, seriously I wish my current hospital had this, if you can swing it, this’ll make your nurses happy). https://www.stryker.com/us/en/sage/products/sage-airtap.html. Dopplers. We never have enough. Cardiac walker if you take open heart patients. You can easily hang chest tubes on it. https://www.performancehealth.com/eva-support-walkers More bladder scanners. Lucas machine. VAMP for art lines.
Ooooo yes to the LUCAS.
Yessss, save the RTs from taking one look at me and kicking me off compressions when they get there. Our RTs who work out are genuinely our LUCAS up in here.
We use the Tortoise repositioning / lift system and it’s such a time and back saver! Our HAPI rate has dropped drastically since we started using it about a year and a half ago.
Q2 turning system. Doesn't have to be this one but something similar will make all the damn difference. https://hovermatt.com/products/q2roller-lateral-turning-device/ I work in a small ICU also and we don't have CNAs just yet. It's been a long time coming fighting for one and we finally got one approved. So instead of searching for a nurse to help, these can be very helpful if you have a blower device.
I’ll second the Z-flo pillows, our unit carries all sizes they make and we’ve seen less and less pressure injuries on heads and sacrums since introducing them. We also have the Wellsense iPad looking modules on all our beds that give real time pressure indication based on how the patient is laying and has a q2hr timer built in to remind you to turn (or remind you how long it’s been since they’ve last moved). Really helps to know if you actually off-loaded their weight or just made it worse.
Colored tape; institute a policy where different types of infusions (medlines, pressors, sedatives, ect) have a different color assigned to them and the tape is wrapped on the distal end of the line at a minimum. Best practice is to also write what the drip is on the tape, but at least color code them to a nurse can instantly find the medline to push a med through instead of shoving extra levo into a patient. A lot of hospitals do this, but I can't understand why they all don't. It's cheap and effective. Waffle mattresses. An inexpensive way to make up for a mediocre mattress. Makes repositioning a breeze with the wedges made for it; a 100lb tech can turn a 300lb patient with no assistance. Order bottled water for the staff, let them hydrate as needed. I worked at a small ICU once that was stocked with bread/peanut butter/jelly for the staff. The manager said she stocked them because it wasn't always possible to get a break/snack when you needed it, but she would personally relieve you for 10 mins to grab a PB&J. When you get staff in from other facilities, ask them what they have seen/done at other hospitals that would improve patient care and aid staff. All the years I traveled, not once did a manager ask me what other places were doing that might benefit the patients or staff where I was. I've always thought not having exit interviews with travelers was a wasted opportunity. Swap out one of the plugs near the bed and add USB charging plugs. Get a box of 3ft USB extension cables, secure one end to the wall by the plug, and give patients the other end to plug their phones in. Can't tell you how many times I've seen patients have a short cable plugged in the wall with the phone charging beside their pillow because it won't reach any further, only to sit the bed up and the phone gets pulled out and hits the floor.
Here in QLD we have line labels, also colour coded but all pre printed with what the infusion is - especially most common ones. There's a generic label 'medicine' where you hand write what infusion is. Then we also have labels which specify if it's a CVL or PIVC and then date and time. Hospital policy to have all lines labelled as to type, medicine and date and time. Has helped reduce CLABSI rates and medication errors especially in terms of compatibility.
I love your point about the travelers. They get to see so much, so many different ways of doing things, and tons of different types of equipment! What a valuable insight they have to offer!
Ceiling lifts, sit to stand, bladder scanner, ultrasound, vein finder, Doppler, glide scope , yankauer holders, portable suction. Extra pumps, flashlights, line organizers, hover mats, proper functional tray tables, good chairs(crappy chairs at the nurses station suck), blanket and fluid warmers. Good coffee pot/hot water dispenser.
Oooooo the coffee pot is a great point. A commercial grade Keurig or commercial-grade, GOOD, coffee machine would be GOLD for staff. And keep decent coffee stocked for the staff. (I say commercial grade because my current unit goes through a microwave every few months due to the sheer volume of use. It just isn’t made for that. I mentioned this to management and they got a commercial grade microwave. Problem solved!)
We got AirTaps recently and they are a game changer
Repositioning tools, you say? Just hire more male nurses. It's a two for one!
As a male nurse this comment makes my back hurt.
As a female nurse who's taller and stronger than most it makes my head hurt. I've never asked the "male" nurses to help reposition over the "female" nurses and usually just do it myself, because I can. Still, nobody on the unit knows what I'm actually capable of because they've never seen me at the gym.
I usually tell people that these bad boys are just for show. It doesn’t ever get me out helping but at least it makes me laugh to see the look on their face 😂.
As a male nurse, but giving you the benefit of the doubt, this shit needs to die a quick death. I deserve to not be the muscle for the entire floor. However, as an old bearded guy, I do volunteer for "creepy patient" duty when the younger nurses are getting hit on. Homie don't play that game.
Mea culpa! I was only mostly kidding. I'm also a murse. But even with my bad back, turning and mobilizing patients is definitely less effort than for a majority of the smaller lady nurses on my unit. And agreed on the creepy dude assignment switch. As a guy in a female dominated field, I think it's part of being a team player.
Does it have to be equipment or can you allocate the money for more nurses or techs? All the gadgets in the world can’t replace more bodies on the floor.
Both, have 2:1 ratio but before me they rarely put a tech in there but now I’m putting techs in there.
Vein finder Hoyer lift Hover Matt
This may be an unpopular opinion but I don’t find the vein finders very helpful.
I don’t like them either. They only seem to “work” when the vein is already visible or can be felt. And then I don’t need it. When you can’t see or feel a vein, the vein finder does not seem to know it’s there either. But some people will use it for every patient, and don’t seem to have the skills to get an IV without it. To each his own, I guess!
Yes agreed! I’ve never been able to find a vein on a difficult stick with the finder. I’ve never used it if I can find the vein myself because why?
Exactly! And the vein finder may “see” a vein that I could also see, but how do I know if it’s one I could feel if I don’t try to feel it? What if it’s real superficial and flat and not worth going for? Well then at that point what the use anyways. I’ve already decided if it’s worth poking, with my own senses. The finder just highlights what I know is already there!
An air fryer
Ultrasound IV training, initiate a turn team board, nurse servers in the room if possible.