ICU training- CATH lab

So my second day of training was spent on day shift in the cath lab, which is pretty much one of my favorite places in the world. I remember cath lab rotations during nursing school felt like one place where everything was right in the world of nursing. Finally nurses are practicing the autonomy they deserve and doctors and nurses are co existing peacefully! So I was super excited about spending the day there and it lived up to all of my expectations!
Sheath pulling (the reason why I was spending a day in the cath lab)
So if the flow sheet is my first nemesis then sheath pulling is my second. As it turns out despite my intense enjoyment during my day in the cath lab, I am terrible at holding pressure after a sheath pull. I tried everything and no matter what all my little femoral arteries were oozing every which way! I stretched my hands and I pushed with all my might 2 cm above the insertion site directly over the site where I had felt the catheter just like the video told me yet I still failed. One patient even developed a nice sized hematoma on my watch! Not that I am proud of these poor results to my treatment but in my defense my teacher for the day would not help me! Every time something started oozing too much or a hematoma started my teacher would just take over the operation instead of helping me to reposition or figure out what the problem was. I only had the opportunity to actually pull 2 sheaths because you have to watch so many before you can pull. I see this as a challenge and am looking forward to meeting a sheath in a femoral artery at work (or in dark alley where I can really show em who is boss (J-lame I know hahaha)) again one day.
I got to have lunch with some of my dayshift people from A6. Furthermore, the hospital fed us for free in honor of hospital week. I made it home in time to snag some groceries and a nap. Overall this day gets a good review!

This is what is being done in the cath lab on the left there is a narrowing of the artery and on the right you can see it has been repaired.

not the lab I was in but this is a typical setup.

ICU night 1

o I get on the elevator and instantly reach for the number 6. Aw burn. Good thing 4 comes before 6 ( my first and only break of the night J) So I am feeling pretty confident as I stroll onto the unit and right into the female locker room – excited to see my promised large locker the assistant manager was supposed to clear out for me. Well there was no locker cleared out for me — “Welcome to your new home Melissa!! wooo we are glad to have you-or maybe not…” hhhmm okay just an oversight I’m sure. I will just leave my bag with all my prized nursing possessions and the photos I prepared for my locker sitting here in the open! Now to find somewhere to stash my lunch! hmmm no fridge here. Drat I guess I will have to meet someone already.
So after finding the breakroom with a fridge I found my preceptor. This is a good time to note that I had a very romanticized vision of my first ICU report. In this vision the nurse giving me report would WOW me with all the information efficiently reported to me in the most organized fashion while a little person massaged feet and another fed me grapes. Instead my preceptor handed me a blank Dr’s progress note form to write on and the nurse informed me that this patient had “JUST GOT HERE” and she was still trying to finish her assessment. In the wonderful world of nursing this of course is code for, “Sucks for you but I know nothing about this patient good luck with your shift tonight.” So after we got report on 2 patients my preceptor says, “Which one ya want?” after a short conversation she hooks me up with the “just got here patient” and hurries me in the room to show me how to use the monitors. After a way too fast tutorial on how to print my patients strips she hurries off to check on her patient since she is expecting the arrival of a not always nice doctor.
So turns out my patient was very confused and being treated for high ammonia. And for those of you who are not lucky enough to have experienced this first hand I will go ahead and tell you there is only one way to get rid of ammonia and its not pretty. But the patient is stable for now so I try to figure out the crazy long flow sheet where I document the patient ongoings. This flow sheet is the enemy- my new nemesis. It is one reaaaaally long piece of paper that consists of 4 8×10 sections on either side. It all folds up together and I am pretty sure that each section randomly switches places with the other sections while your not looking to make it virtually impossible to ever find the section you seek.
Just as I am feeling really defeated by this dreaded piece of paper the doctor shows up to see my patient. He decides to order the med as an enema since my patient is in no mood to swallow (HOORAY -I think- since I would prob never get an NG tube down her considering trying to listen to her posterior lung sounds was like wrangling a wild cougar). So the enema is Q12hours meaning we only have to give it once during our shift. WE of course decide to give it in the wee hours of the morning so we can give her her bath afterward.
Every hour I have to chart vital signs and urine output then every fours hours I have to do a full assessment. Now I know this doesn’t sound like a whole lot but you musn’t forget about the transforming flowsheet where I document this info. And then there are always the “Chores” assigned to each nurse, things like “Check the crash cart” or “Code team 1” or “Code team 2”. We got the awesome job of counting narcotics and I was nominated to count. I am usually very good at counting, as are most people > than 6 years old. But this particular night I was not very good at counting and after approximately 7 miscounts we completed the count only to find out- via a visit from our friends from the pharmacy- that we had still miscounted one of the drugs. Woe is me.
The rest of the night was pretty uneventful. I searched for the enema bag for like 20 minutes before admitting defeat and asking for help to navigate the carelessly organized supply room (earlier in the night I found urine specimen cups in the same drawer with soap, shaving cream, deodorant, razors, and non-slip socks!). We quadruple pad the bed give the enema and cross our fingers! After an exhausting bath that once again can be likened once again to a cougar (imagine giving him a bath) we get everything settled down clean sheets and all only to discover the enema was still making its reappearance into the world. I am pretty sure we did this 3 more times before we decided to not check for leakage for a while…
At 0630 just when we settled down to review our information for the morning report the shift coordinator called to tell us good morning and announce that there was a bed available so our other patient could be transferred to the floor! Being the over achiever that I am I insisted on helping with the transfer only to prove that I apparently need to go back to driving school because I CANNOT steer a hospital bed. I somehow wound up pushing the bed all the way back across the sky bridge to the Critical Care towers all by my lonesome. This adventure ensured that I would be red faced and drenched in sweat to meet all of the AM shift employees!
I felt thoroughly defeated during my drive home and I was pretty much loathing my existence so I decided there was nothing to do besides shop it out. So I took myself and my skanky scrubs into walgreens and bought everything I could find with a sale sticker and went home to drown my sorrow in lucky charms.

HELP ME! I am drowning in this flow sheet!!

ahhh sweet release!

Goodbye tele-nurse! Hello Critical care nurse!

On the eve of the complete mix up of my nursing career (from what it has been for the past 10 months), I am excited, scared, apprehensive, and did I mention SCARED?

I did get the opportunity to meet my preceptor on Saturday night while I was working. She was very sweet and seemed genuinely excited about me coming. So I feel a ton better about that part of this adventure. I remain scared mostly about my knowledge base. I am definitely going to have a lot of studying to do in my near future. I just hope that I have a stronger pharmacology reserve than I feel like I do!

Anyways my plan is to stick to the skills that I do know and take notes on what I need to study. My plan is to update the blog often so everyone can experience this new chapter in my life Thanks for reading!