Third time's a CHARM! not

In my entire life I only remember getting light-headed/queasy/clammy-feeling 3 times. Remember the last time it happened? I wrote all about it here. Yeah, it was super embarrassing and humiliating but hilarious at the same time. I thought I'd learned my lesson and had experienced my "I almost fainted" story that every nurse (and doctor) has, but I was so completely wrong. It happened today. However, the third time I felt this horribly disturbing, I-have-no-control-over-what-is-going-on, feeling I was dumb enough to assume that it would pass if I looked away and thought about something else, made sure to bend my knees and took deep breaths. Wrong again! Because this time I actually FAINTED. Totally. Completely. I was out. 

Despite your assumptions that I was seeing something terribly gruesome and bloody, the culprit was actually the silly, inconsequential thing of watching the anesthesiologist put in an epidural. Yeah, super wimpy, I know. 

The funny thing is that I went in and watched a c-section as soon as I was "recovered" (aka face was no longer deathly white, my BP was back up, and I was no longer clammy and dizzy). And I wasn't bothered in the slightest. Despite the cutting, the blood, the splashing fluid, the cauterizing, the snipping, the pulling, the emerging baby, and the stitching back up. Yeah, I'm ridiculous. 

If you want to know what it feels like to pass out, read on (don't worry, I'm going to describe it, not share something sickening that will make you pass out) 

I was standing in the room, it was about 6:45 am, observing my nurse interacting with the patient. My mind started imagining me in this situation, with my future husband supporting me as I'm about to deliver a baby. The anesthesiologist walks in and starts to prep her skin for the epidural. "Oh, no bid deal, I've seen them come out and I'm definitely comfortable with needles," I thought. He gets his tray ready and then I see it. This black and white striped, thick, extremely long needle. "Whoa, that's a really big needle." He numbed her up with a small needle first and then takes this gigantic thing and shoves it into her back. And she doesn't even flinch. "That is really weird, I can't believe she doesn't feel that going in." Suddenly I started to get a little light headed. "Look away, take a deep breath, think about something else, and you'll be fine," I kept telling myself. So, I started day dreaming (or so I thought). I was very absorbed in this dream when suddenly I hear someone say, "are you ok?!" I cracked my eyes open and the first thought that popped into my head was, "this is a weird dream, I'm glad it's not real life" and then, "oh my goodness, this is real life and I am on the floor in the hospital with all these green scrubbed people looking down at me. I must have fainted. How embarrassing!"  Of course they call for help and give me juice and make me feel even more humiliated about it. And the dad-to-be is over there asking about how I'm doing instead of paying attention to his wife. Darn body, what's wrong with you? 

Like I said, after that I watched a c-section (this was a very strange thing, but really quick), saw another vaginal delivery, inserted my first catheter (yay!) and then went home. It was a very eventful day, and 100% great except for my fainting episode. 

Lesson learned: sit down when you feel light headed! You won't win this, no matter how hard you try.  However, this experience was far less embarrassing than the last time, when I really didn't faint. But being completely realistic, I was really blessed not to hit my head or get injured when I fell. If it wasn't for that, I'd say fainting is the way to go instead of drawing all the attention to yourself by saying you're about to faint...

Here's to hoping this will never happen again. Cheers! 

p.s. This was my last day on Labor/Delivery. :( But, next week I'm in Pediatrics!

IV's!

Today I inserted my first IV. Ever. Also, I was injected with my first "IV" (I have had my blood drawn once before...but that doesn't really count). It was awesome! I loved it :) I was so nervous, but luckily I got to be poked first and that took away my nervousness. Brittany consented (again) to by my partner. She was great! I wanted to be able to post pictures of this monumental occasion, but, alas and alack, taking a picture is the last thing I think about when Brittany's blood is squirting all over my gloves.

To help me remember all the things we learned in lab today, I wanted to summarize it on here. It may be quite boring, so don't read on unless it interests you :) Here we go:

IV stands for intravenous. Intravenous therapy is so important as it is the fastest way to get electrolytes, fluids, antibiotics, and other medications into the body. Because of that, it is also very dangerous--once it's in, there is no correcting things, so don't make a mistake! IV's are so important in surgery (being able to replace fluid as blood is being lost), in emergency situations (dehydration, fluid excess, etc.), and having a better way to regulate medications or fluids in the hospital or clinical setting.


When you insert an IV you need to pick a vein that is elastic and healthy. You always see IV's in the forearm, but apparently you're supposed to start as distal (furthest down the limb) as possible. So you start on the hand if they have a healthy vein there. You do this so that if a vein bursts or becomes occluded and you need to move to another you still have options. If you started more proximal (further up on the limb) all the veins below the injection site couldn't be used because the blood flow would already be messed up. SO...today we started on the hand. Here are the steps we learned (I gave them my own numbering and grouped them in that way that made sense to me):

Step 1: Wash hands
Step 2: Introduce yourself to the patient, identify the patient (you know when nurses ask you about a million times to tell them your name and date of birth?), ask about previous IV experience, and explain the procedure.
Step 3: Gather supplies

Step 4: Put tourniquet on the patient to back up blood to find a good spot to stick-once found, mark the spot with either your fingernail or a sterile pen.
Step 5: Remove the tourniquet to allow blood flow again to the limb
Step 6: Clean the area with Chlorhexidine liquid application to kill the bacteria and allow to dry
Step 7: Prep your saline flush, open dressing and gauze
Step 8: Put the tourniquet back on-making sure you don't touch the area you just cleaned
Step 9: Put on gloves
Step 10: remove cap from needle, place thumb to pull skin taut, position your body directly in line with the place you're inserting the needle, put the needle directly on top of the vein, warn the poor soul you're poking, and PUSH.

Here is a depiction of pushing the needle into the vein.

This is the catheter-it shows all the parts that I'm talking about. The cannula is the "hub," the knob is the "safety" to retract the needle, and the blood chamber is where, obviously, you'll see the blood flash.

Screw on the Saline Flush

Once you're in the vein you should see a flash back of blood. When you see that, insert the needle a tiny, tiny bit farther. Then, while still holding everything stable but without touching the skin you've cleaned, advance just the catheter up to the hub. Then, using your non-dominant hand (making sure you still hold on to the catheter with your dominant hand!) remove the tourniquet, apply pressure with your middle finger on the vein just above the catheter (to stop the blood from squirting out all over), stabilize the catheter with your first finger from your same hand--it's kinda a loooong stretch (remember, no touching the skin or it becomes contaminated-only the hub of the catheter), let go with your dominant hand and push the safety to retract the needle, dispose of that in the "sharps" container, grab the saline flush, remove cap with just one hand (make sure you keep it sterile), and screw on to the catheter.

Whew! Can you tell that it's kind of a stressful process? You then flush it with saline to make sure the vein is not occluded, secure it with the dressing, and date, time, and initial on top of the dressing (you have to change the IV every 72 hrs) and from there you can attach whatever it is you need to be putting in the vein.


And there you have an inserted IV! You have to watch the site carefully to make sure the vein or the skin around the insertion site has not been irritated and to make sure the fluid is actually going in to the vein. Watch for redness and swelling to make sure there isn't any clotting or emboli.

And, because we've learned it so SO many times (to make sure we know how critical it is), know that you never NEVER never never  allow anyone to push potassium chloride. It is fatal.

Anyway, I hope that someone learned something about veins and IV's and that this information is better cemented in my brain.

And in case you're wondering-the veins in my hand refused to cooperate, so Brittany had to move up my arm to the AC (antecubital fossa aka the spot right where your arm bends :). Brittany had much better veins in her hand, I just accidentally forgot to put pressure on the vein before I pulled the needle out...and blood went everywhere! I still need to practice a lot, but, surprisingly, it was fun (is that sick?), and I really want to get good at it. You're only allowed 2 tries in the hospital you know.

ttfn, ta ta for now!

Shots

On Wednesday I had my first experience giving shots. And, the end result is that I have so much less stress than I did before!

I have been really worried for months that I would not be able to give shots without getting dizzy or faint. All growing up I was fine with needles and blood, but in the past year, the 3 times I have had to draw my own blood for labs, or had to have my blood drawn for a test, I have gotten really light headed and shaky. I wasn't sure if it was because of the blood, the needle, or because I was a wimp and didn't like the pain. But I was worried.
So when I went to class and was able to give three shots with quite long needles to a real live person, without passing out, I was quite excited.

We learned about the parenteral routes (injecting medicine into a tissue) of med administration:

• ID shots or intradermal (into the dermis) are what they give for shots like the TB test, where they need to be able to assess the reaction of your skin to whatever substance they injected into you. 
• IM or intramuscular (into the muscle) are the shots you get for most other things: immunizations, flu shots, strep shots, etc. 
• Next week we'll learn about Sub-Q or subcutaneous (just below the dermis) injections. You use these to administer things like insulin to a diabetic patient. And then next semester we'll learn about IV or intravenous (into the vein) shots.

We gave the ID shot in the forearm. The way to figure out where to give it is to go three fingers down from the elbow joint (on the front or your arm). You insert the medication just below the surface and it creates a little bleb, or white bump on your arm. We did this one first and it was probably the most painful because it basically rips your skin apart in the one little area. We gave the IM injections on the deltoid muscle and the ventrolgluteal muscle.

Poor Brittany gave me all my shots and we realized quickly that I bleed a ton! When I stabbed her she hardly bled at all, but when she poked me I was gushing. The worst/funniest time was when she was getting ready to poke my thigh. I was expecting her to practice once with the needle cap on (like we had both done on the deltoid and I had done on her ventrogluteal) but she didn't need to. So, when I felt the needle I was so startled that I jerked and she had to pull the needle out. It hardly hurt at all, but there was blood everywhere! So, she cleaned it up, got a new needle, and had to do it again. Sorry Brittany!

But it was awesome! Definitely a good experience overall. Thinking back on it I can't believe I was able to push those 1 1/2 inch needles all the way up to their hub into Brittany's muscle, but now I know that I definitely can do it. And I am starting to fee like a real nurse! :)