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Tom Sharon
Watching tubes, wires, nurses and a lot more


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Protecting Yourself or Your Loved Ones in the Intensive Care Unit

  * Take a look at the tubes and wires and ask the nurse to explain what each one is and what it is for.
  * The intravenous lines have a drip chamber. Look at this to make sure that the fluid is still dripping. If it is not, call the nurse.
  * For intravenous lines in the arms, look at the insertion site for any swelling and/or redness. If you see any of this, tell the nurse and continue to follow up until you get action (see "Infusion Lines").

  * If the doctor ordered a transfusion of blood or blood by-products (fresh frozen plasma or platelets), do the following (see "Blood Transfusions")
    - Make sure the nurse matches the serial numbers and the blood type between the transfusion ticket and the label on the blood product unit in the presence of a second nurse. This will help to avoid transfusion reactions from mismatch.
    - To avoid receiving tainted blood (contaminated with the AIDS virus, syphilis, or another infection), tell the nurse and/or doctor that you will not accept blood received from paid donors (such blood must be labeled).
    - For elective surgery, ask your doctor about autotransfusion (removing and storing your blood prior to surgery to be infused if needed).
  * If your loved one has a feeding tube, make sure the liquid nutrient is not going in too fast.
    - If there is any complaint of fullness or nausea, get the nurse to turn off the flow immediately.
    - If vomiting occurs, turn the patient's head to one side to prevent choking.
    - If there is any diarrhea, insist on having the feeding discontinued until the problem is resolved.
  * If there is a bladder catheter, do the following whenever you visit:
    - Make sure the catheter is not kinked.
    - Make sure the catheter is anchored to the thigh.
    - Check the urine in the bag to see if it is clear yellow. If it is cloudy or bloodtinged, tell the nurse.
  * If there is a kidney catheter, take the following precautions each time you visit:
    - Check to make sure it is still attached.
    - Check to make sure it is not kinked.
    - Check the urine bag as for a bladder catheter.
  * Keep a careful accounting of how much blood the nurses and doctors are taking out of the central vein or arterial lines. More than 100 cc would be excessive and could lead to severe anemia.
  * Throat tubes must be properly maintained to prevent mouth or throat ulcerations as follows:
    - The nurse must deflate the internal balloon every eight hours to prevent pressure ulceration of the vocal cords.
    - The nurse must reposition the tube every two hours to prevent pressure ulcers within the mouth.
    - The connecting tubes must remain clean and dry.
    - The nurse must provide frequent suction and occasional tracheal lavage (squirting about a teaspoon of saline into the breathing tube and applying suction).
  * Tips for peritoneal dialysis patients and their loved ones include the following:
    - Check the credentials of the nurse providing dialysis.
    - Make sure the nurses are not contaminating the insertion site.
    - Make certain the nurses keep the system closed as much as possible.
    - Make certain the nurse takes blood for laboratory tests as needed and follows up on the results.
  * Tips for hemodialysis patients and their loved ones include the following:
    - Make sure that decontamination procedures are being performed between patients.
    - Make sure the nurse does not inject the connecting needle into any previous needle marks.
    - Ask the nurse to demonstrate that he or she is performing proper maintenance on the dialysis machine.
  * To reduce the psychological impact from the intensive care unit, do the following:
    - Stay with the patient as much as possible.
    - Place personal items at the bedside as permitted.
    - Provide miniature entertainment devices, such as a portable DVD player or a laptop computer.
  * Pay attention to how many patients your nurse is assigned to. If there are three or more, lodge a complaint with administration, and follow up with the health department if you do not get a satisfactory response.

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