Velefunt

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I think it should be said. Never trust an IV that you didn't place yourself (or watch someone place). I'm sure we all have stories about IVs from the floor.

Old school nurses have the skills. The new breed seem quite weak with IVs.
Regarding Floor/ER PIV's, I've discovered an inverse relationship to how elaborate the dressing is, to how well it may flow. If there's all manner of gauze padding, fancy taping/cross taping and multiple layers of Coban (and it's running 10ml/hr on a pump), it's highly likely that peripheral IV is strictly ornamental.
 
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MirrorTodd

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Anybody else using intraop MAP>65 as a quality measure? My group has decided to do this so I’ll be running a lot more norepi and phenylephrine infusions this year. Apparently an intraop BP of 90/50 is not “quality”.


Is phenylephrine so cheap that the pharmacy wouldn't notice an uptick? Like that seems a little redonk. Hospital I'm currently at premixes phenylephrine as 100mg/250ml. It seems like a huge freaking waste to me cause I might use like 5-10cc for a 1-3 hour case depending.
 
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We'llBeDoneIn15Minutes

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Ultrasound guided, long axis, in plane technique with a long angiocath (1.75inch). Takes a bit to learn, but once you master the technique, it’s very hard to miss a vein.
Prefer short axis, minimal needle advances, ultrasound scanning to find the the tip, repeat till you have enough in the vein to slide off, but agree with the conclusion: Very hard to miss a vein.
 

repititionition

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vector2

It's not what you know, it's what you can prove.
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Nonsense study. Retrospective, not prospective. Propensity matching magic. Furthermore, “More patients who received a phenylephrine push achieved hemodynamic stability at hour 3 than those who did not receive a phenylephrine push (28.4% vs. 18.8%, risk difference 10%, 95% CI 0.9% to 18%).”

If you have someone in shock and at HOUR THREE only 18% of your control group has achieved hemodynamic stability, then either you don’t know how to titrate norepinephrine or both your cohorts were filled with people who were going to imminently die anyway.
 
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Agree with vector, this study is dumb af and so are the people who thought of it.
 
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Hork Bajir

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Studies like this one make me think I could become a professor. WTactualF thought this study was a good idea...

If this garbage gets published, be on the lookout for my forthcoming paper: does oxygen increase SpO2? A meta-analysis
 
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SaltyDog

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If this garbage gets published, be on the lookout for my forthcoming paper: does oxygen increase SpO2? A meta-analysis

I think that one was actually in last month’s Anesthesiology News.

It was right after “Sick Patients Do Worse” and before “Patients With Pre-Op Pulmonary Dysfunction More Likely To Have Post-Op Pulmonary Dysfunction”
 
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vector2

It's not what you know, it's what you can prove.
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Studies like this one make me think I could become a professor. WTactualF thought this study was a good idea...

If this garbage gets published, be on the lookout for my forthcoming paper: does oxygen increase SpO2? A meta-analysis
I mean it’s unbelievable it was published in Chest of all places. It’s as if Anesthesiology published one of the book reports that the nurses write nowadays to get their “doctorate”
 

IlDestriero

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Recently had a case where a healthy 40 something year old had a cysto and stent placed for obstructing stone and pyelonephritis. Hypotension in PACU, got about 3L between ED and OR, peeing a bunch, antibiotics in. MAPs now in high 50 to low 60s, systolic as low as 80. Patient looks fine, asking when she can go to work, mild Leukocytosis. I called hospitalist and told them she needs an ICU bed for overnight (no PACU coverage to board overnight).

what would you do?
1. Peripheral norepi overnight
2. Peripheral phenylephrine overnight
3. Central line, norepi overnight
I’ve had a few of these kinds of patients release the evil humors and tank in the OR even though they were hemodynamically stable pre op. I’d place aline and central line in the OR, start norepi and send to the unit ASAP. If they were really shady, I’d probably leave them intubated and let the icu see what they look like in a couple hours and decide if it was a good idea to wake and extubate.
 
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