An informal discussion ofemergency nurses' current clinical practice: What's new and what works

Emergency response plan

Evie Bain, MEd, RN, COHN-S, Occupational Safety and Health Specialist at the Massachusetts Nurses Association, says that you can download an excellent resource to use as a benchmark for the plan that your hospital has developed— “OSHA Publication 3152-1977 Hospital and Community Emergency Response, What You Need to Know,” www.osha.gov , www.cdc.gov , and www.cdc.gov/niosh all have daily updates on our most current pressing issues related to severe acute respiratory syndrome, including strategies for infection control and worker protection, as well as information on all aspects of emergency preparedness.

Whenever you go to one of these Web sites, be sure to make copies of the materials and bring them to work with you to post on the bulletin board and share with your coworkers.

Recently, in my school system in Waterbury, Connecticut, a coordinator from the hospital emergency department (St Mary's Hospital) was assigned to help the high school with its preparedness. The ED personnel, fire department, and city department of public health provided education to the teachers so that they can respond appropriately to the emergency response plan.

Easy sling application

Stephanie Baker, Director of Emergency Services at the Paradise Valley Hospital in National City, California, recently gave me a quick tip in sling application. She says that when she applies a sling to the patient's arm, she always asks the patient to assume the “pledge of allegiance” pose (hand over heart). This helps her to position the sling correctly and helps the patient remember to keep the arm elevated above the heart when reapplying it at home.

Nursing home “hot sheet”

Baker also shares a tip for ED nurses with regard to nursing home patients who are admitted to the emergency department. She tells me that they are currently working with 5 nursing homes in their hospital area from which they receive patients. They are developing a 1-page “hot sheet” that has pertinent information about why the patient is coming to the emergency department, the patient's code status, allergies and primary physician, and so on. We have all experienced those 30 pages of copies from the nursing home that we need to wade through in order to get the pertinent information on what is wrong with the patient. She tells me that the sheet will be brightly colored, so that the ED staff can find and use it easily.

Latex gloves

While outside gardening today, I was reminded of an incident that occurred last summer when my son came home from a dishwashing job with red, itchy hands. When I asked, he said that the gloves he wore at work were “rubber.” Despite my urging to wear non-latex gloves, he continued to wear the rubber (latex) ones and, as a result, ended up progressing to a severe anaphylactic reaction. If you have patients with a local or systemic reaction after washing dishes or gardening (gardeners wear gloves, and all too often now, they, too, are made of latex), tell them to find out what is used to make the gloves they wear. Latex may be the culprit!

Another catheter tip

I have always inserted a catheter into a patient's bladder, watched for urine, inflated the balloon, and pulled back on the catheter a bit to make sure it was in place. Beatriz Hayakawa, Clinical Nurse Specialist in Urology Nursing at Mercy Hospital and Medical Center in Chicago, told me recently that in men especially, this is not a good practice. When the catheter is tugged after the balloon is inflated, it can become lodged in the prostate urethra and also causes tension to the urinary urethra that can result in a little hematuria. She teaches the resident staff and nursing staff at her facility to insert the catheter into the urinary urethra all the way to the hub of the catheter (y site of catheter). When the catheter is inserted all the way to the hub, she instructs the staff to wait for a good amount of urine return before inflating the balloon. That urine will be your verification that you are, in fact, in the bladder and that it's safe to inflate the balloon. The excess catheter tubing will slide back out of the urethra on its own, and the balloon will gently rest against the wall of the bladder without causing any trauma. She also recommends using a coudé (the type of catheter with a slanted end for easier insertion) with all males older than 50 years. She says they usually have a bit of an enlarged prostate and the coudé makes the insertion gentler. Hayakawa uses lidocaine jelly for catheter insertion, and believes that it is helpful with pain relief and slightly dilates the urethra so there is a less traumatic insertion. She tells me that patients who have had a stroke find a belly bag more comfortable than the regular drainage bag attached to their catheter. The belly bag works with bladder pressure and is worn like a fanny pack at the patient's waist. The patient can be more mobile and safer because there is no tubing to get in the way or be stepped on. The belly bag has an anti-reflux valve, and the way the bag is constructed, it will drain out, even though the bag is literally lateral to the bladder.

Clinical questions from nurses are welcome, as are names and addresses of clinicians who are interested in answering questions. Submit to: Deborah Blazys, RN, BSN 529 Middlebury Rd, Watertown, CT 06795 203 274-8568 • eadistefano@snet.net