Drilling into Bone: A Nurse’s Guide to Intraosseous Vascular Access

By Sylvia Foley, AJN senior editor

An example of a pediatric manual intraosseous needle insertion. Used by permission. An example of a manual pediatric intraosseous needle insertion. Reprinted with permission from King C, et al. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2007.

In this month’s CE Emergency feature, “Intraosseous Vascular Access for Alert Patients,” authors Stacy Hunsaker and Darren Hillis  describe this scenario: a three-year-old girl arrives in the ED after three days of fever, vomiting, and diarrhea. She needs fluids urgently, but efforts to establish IV access have been unsuccessful. Now she’s on the verge of decompensated shock. The team is about to try an alternative route—intraosseous (IO) vascular access—but there are concerns: “Could such access be attempted on a patient who wasn’t unconscious? Would the parents understand why a hole was going to be drilled into the bone of their child’s leg?” The team must decide whether and how to proceed.

If this child were your patient, would you know what to do? If you aren’t sure, you are not alone. In this article, Hunsaker and Hillis provide some answers. Here’s a short summary. […]

2017-07-27T14:49:36-04:00October 31st, 2013|Nursing|4 Comments
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Domestic Abuse Patient

By Karen Roush, MS, RN, FNP-C, clinical managing editor

All rights reserved. Photos by author. All rights reserved. Photos by author.

It’s the end of October—Domestic Violence Awareness Month. I want to tell you a story about a patient I had in the Adirondacks in upstate New York.

The young woman was back for the third time that month. The previous week, complaints of vague abdominal symptoms had brought her in; this time, it was frequent headaches. Even as I performed a neurologic exam, I suspected I wouldn’t find  anything.

“So, how’s everything at home?”  I asked, after assuring her there was no sign of a neurologic issue.

“Same,” she told me. “Yesterday I forgot to get his cigarettes and [expletive]! you’d a thought I killed someone.”

“Did he hurt you?”

“No. Just twisted my arm a little. I’m fine.”

But she wasn’t fine. She suffered from anxiety, headaches, chronic back pain, and irritable bowel syndrome. She had been through numerous diagnostic evaluations, including invasive procedures, and had tried multiple medications.

She was 25 and had three children. I’d brought up the subject of intimate partner violence after her second visit, but it wasn’t until she’d been seeing me for a few months that she felt safe enough to talk about it. Her husband […]

2016-11-21T13:06:11-05:00October 29th, 2013|nursing perspective|2 Comments
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Guess Who’s Wearing Housekeeping Garb Now? Surprise! It’s Your Nurse

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Catch-all: noun [usu. as modifier]

a term or category that includes a variety of different possibilities: ex. the stigmatizing catch-all term “schizophrenia”

American Hospital/by J. Paradisi American Hospital/by J. Paradisi

The first thought that came to mind after I heard that Vanderbilt University Medical Center had laid off its housekeeping staff and assigned cleaning patient rooms to nursing was this: Has anyone from the hospital’s administration ever looked inside the nursing staff’s refrigerators, microwaves, or sinks?

Universally, nurses’ staff lounge kitchens nearly rank biohazard status. In every unit a single nurse, but often it’s the unit secretary, martyrs herself (or himself) by emptying these refrigerators of forgotten food. She washes the moldy containers and places them on a nearby countertop, with this message scrawled in Sharpie:

CONTAINERS NOT TAKEN HOME BY WEDNESDAY WILL BE THROWN OUT! (Caps intended)

Another sign commonly posted above the staff lounge sink or microwave by this same nurse or unit secretary reads:

CLEAN UP AFTER YOURSELF! YOUR MOTHER DOESN’T LIVE HERE!

Fact: Nurses know a lot about infection control, but this does not automatically make us good housekeepers. Besides, nurses already have a job: keeping hospitalized patients safe while assessing their needs and administering their care.

While Vanderbilt’s decision to lay off its housekeeping staff and assign […]

2018-03-28T10:28:19-04:00October 28th, 2013|career, nursing perspective|15 Comments
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AJN’s November Issue: Voices of New RNs, Intraosseous Vascular Access, Measuring Dyspnea, Coccidiodomycosis, More

AJN1113 Cover OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

New RNs. Hospitals invest in orientation or residency programs for newly licensed nurses, but turnover rates for first-year nurses remain relatively high. This month’s original research article, “Hearing the Voices of Newly Licensed RNs: The Transition to Practice,” looks at the orientation experience of new nurses in order to explore how institutions can best transition new nurses from an academic to a clinical setting. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

Starting an IV. Nurses are often faced with the challenge of starting an IV line in a patient who is dehydrated, has suffered trauma, or is in shock. This month’s Emergency CE feature, “Intraosseous Vascular Access for Alert Patients,” describes how nurses can use this fast, safe, and effective route for delivering fluids and medications when IV access fails. Earn 2.1 CE credits by reading this article and taking the test that follows. Don’t miss the video demonstration of the placement of an intraosseous  (IO) needle in the proximal tibia using an IO access power driver (click on the video icon on the […]

2016-11-21T13:06:12-05:00October 25th, 2013|nursing perspective, nursing research|0 Comments
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American Academy of Nursing Spotlights Veteran Health Care, Names New ‘Living Legends’

By Maureen Shawn Kennedy, AJN editor-in-chief

Have You Ever Served? For me, the annual meeting of the American Academy of Nursing (AAN) is a great venue for networking and connecting with old friends (including some from nursing school days 40 years ago). And there are always interesting sessions such as the Living Legends awards and a presentation about veterans’ health.

Few schools of nursing teach nursing history anymore, and unless you’re plugged into a professional association you won’t know about the accomplishments of those who’ve shaped the profession. That’s a shame. Nursing has been rich with women and men of action who’ve forged new ways of thinking about, practicing, and teaching nursing. At this year’s AAN meeting, four nursing movers and shakers were added as “living legends” (the Academy’s highest honor) during the event that’s always a highlight at the annual meeting. This year’s “class” includes:

(Ret.) General Clara Adams-Ender, whose army career began as a private and ended as a brigadier general (she was the first nurse to become a general!) and chief of the Army Nurse Corps.

Hattie Bessent, a staunch advocate and leader in creating opportunities in nursing for minority groups.

Margaret Miles, a pioneer in pediatric nursing whose research and work with parents of critically ill children has led to family-centered care practices in ICUs.

Jean Watson, whose ground-breaking theory development, research and practice around the science of caring is known around the world.

The health needs of veterans. Another […]

2016-11-21T13:06:13-05:00October 24th, 2013|nursing perspective, nursing research|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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