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You gotta understand the first thing that you do,
...you have to check with the RN. You gotta go find the RN.
and communicate with them what's going on before you go
into that room, okay? So, if Annie was the RN, I'm gonna go up to
Annie: "Hello RN Annie, how you doing today? --I'm fine.--
Good. I'm going to go into your isolation room is there anything I need
be
concerned about? Yes, you need to wear gloves, mask and gown.
Oh, put on all the PPEs (personal protective equipment)? Okay, but there's no PAPR (powered air-purifying respirator)
No? --No, I'm sorry?-- No PAPR (powered air-purifying respirator)? Respirator?
Okay. So what I'm asking her: there's P-A-P-R, that's a PAPR (papper),
you know, know kinda that movie "Outbreak?"
Where they're you know putting something over here and totally,
fully engaged in that mask, and inside they're breathing the air,
they're not breathing any outside air. That big mask? ...I used to have one over here...
Oh, you know, right here?
Okay, that's like a PAPR. Okay, if you need that, you usually use something of this nature
for airborne, uhm, tuberculosis, ...kind of rooms. and this is also stationed outside the
patient's room.
Whatever PPE's you're needing to wear are going to be
outside the patient's room. Okay? Most isolation rooms,
have what is called an "anteroom." (a separate room area before the patient's room)
So, you'll get in this room first, before you actually get
where the patient's room is. Okay? It's a little room, it has a sink, a
trash can and,
a biohazard container, you know, something of that nature.
So this is just the anteroom where you can clean up before/after
you go in the patient's room. Okay? then you go
into the patient's room. The important thing to remember about going into the patient's room
or for that matter that anteroom is, if you're outside,
you only want to take inside the various
equipment that you're going to use. So, again, outside the patient's room is where
you're gonna find you
PPE's. You have to put them on
outside the patient's room. Okay? you're gonna have gathered
your belongings. Whatever you need to take in, and
if you have everything inside here, this plastic bag,
you know, it's okay to bring your tray
into the anteroom, but you won't take it
into the patient's room. You all get that? Okay. So, again,
you want to make sure that you have everything
in here because you don't want to have to go back out in the corridor or hallway
for anything
because you would have to disrobe and everything. You understand what I mean? And then put everything back on
to go in there. So you want to make sure you have everything you need.
So, I'm gonna go ahead and put everything in here that I want to take
with me... Sometimes it's better to take
more than what you need than not enough. Keep in mind of everything that you take in,
the only thing that's actually coming out of this bag
is going to... out of the ROOM, I should say, is going to be
the blood cultures, okay?
When it's all said and done with, the only thing that's coming out of this room,
the room and the anteroom is
the double-bagged blood cultures. That's it, okay?
You guys still with me? --Yes-- So, I guess I'll go ahead and... (gown up)
--it's a better color-- (smiling)...I'm trying to wear more pastels now...
Anyway...
I tell you, when you have to do this,
this will be on a day
you don't wanna be bothered with this kind of stuff. The day you spent
hours curling your hair. Then, you have to put on the PAPR, and it's gonna totally mess it up.
It's gonna be the hottest day of the year... --sweat it all out...-- Yeah, well yeah. As soon as you put on a mask...
You get what I mean? But then, this is what we get paid for.
Okay? It's part of what we get paid for... So, excuse me... Okay...
Right now this is kind of what you would put on
outside in the corridor, okay? Now I'm gonna step into
the anteroom. I'm in the anteroom, okay?
So, I'm going to go ahead and put on my gloves now... --Gown, mask, outside the anteroom, gloves, inside the anteroom...--
(Note: The gown sleeves are tucked under the gloves!)
Can someone hand me that blood bank form? Thank you. I have to have something to ID my patient with.
Knock, knock! (Patient: Hello?) Hello! I'm here to draw blood from you.
My name is Simone. Is that going to be okay? So I'm going to leave it open,
just so you guys can still see. I'll work on this side.
Can you please tell me your name? Full name? Date of birth? Thank you! Inpatient, so there's one more thing: MRN
I always ask out loud, but I'm always still constantly looking here. Okay?
Alrighty, so I'm going to just set that down here,
and again, you want to definitely have some,
You want to be organized.
You want to work quickly, but accurately.
Hello! I'm going to tie this tourniquet on and try to feel for a vein... Okay?
How you doin' today? (Patient: I'm sick, that's why I'm here...) (laughter)
Okay. Alrighty. So I've felt for the vein. I know what I'm going to use...
(oops, don't have everything in here... Sorry guys...) So now I'm going to go ahead and,
...and remember, if you wanted to make an
indentation (indention) you do that right now. You understand what I mean by that? You felt...
Everybody's looking at me... You understand me? The indentation? All: --Yes.--
Okay, so. He's got a good vein. I don't need to. I'm just gonna start
with the alcohol now, okay? So, if that's the case,
I don't have a sterile tourniquet, so I'm gonna put this
tourniquet on, but I'm not going to put it on as tight, but I'm going to still have it tight enough,
so I can get the blood flow. You understand what I mean by that? So...
Sir, I gotta clean this for about a minute, okay?(Patient: Why you gotta clean it so long?)
Well, we want it really clean because you're going to have some blood cultures here.
So part of the procedure is to make sure your skin, where the site is, is really clean. Okay? Thank you.
(Patient: Okay, I guess.)
Okay. So while that's cleaning, or drying, I should say at this point. I'm going to come over here, work a little faster.
(Arranging supplies on bed...)
As I tried to tell you sir, this procedure takes a little bit longer, but we're going to get there
starting in one second, here, okay? Again, talk to them, tell them what's going on, it's going to help you...
Okay. Sir, you're going to feel a little poke here. ...doing okay? Beautiful.
(Patient: How much blood are you taking?) Well, we're taking a little amount, sir. The minimum amount is 3ml, but the maximum is
10ml. (Patient: Don't you have 3 bottles there?) Yes, I do.
(Patient: Well, do you have to take that much?) No, I don't sir.
I can just put 3ml in each bottle and that will be good enough for us, okay?
Alright. (Patient: That's much better for me, I need my blood. I don't want a transfusion)
Yes sir. Thank you. I'll leave some, okay?
Can you apply pressure for me or bend up your arm? (Patient: Does it look like I can?)
Well, I'll help you hold that, okay?
Alrighty. So, you know, if we needed to have a dispenser there and we don't...
You know, this could really be your reality right here...
Sir, I really need for you to hold this here for me... And they're usually able to bend up their arm.
Like that. I'm just dealing with a mannequin that can't!
Okay? This, you know, again, we don't want to
set our needles down. The same thing we practice out there is the same we
wanna practice here. So don't set it down, there'll be a sharps container,
Around, in the patient's room, so, go ahead and put it in there.
Okay. So now I have to label.
This is the part you don't like to do, because you still gotta be in that patient's room.
But you still have to label. Time, date,
sign initials. I drew the
right arm, and its No. 1, No. 1, No. 1.
Label... Almost out of your way now, sir...
Beautiful...
Okay, remember we can't take anything
back out there, right? Only what we need.
So, here'e my label... I mean, here's my FORM.
So I wanna make sure I have the time and date on the form, and the site as well.
You understand what I mean by that everybody?
The same information I put on the label, Yes?
Anywhere. Just anywhere on the form, just somewhere they can read it.
It doesn't specify. (gathering specimen) Okay, may I take a look at your site?
I'm going to bandage it now. Thank you! You have a good day!
I let this bedrail down, I have to put it back up.
If the patient falls out, it's going to be my fault, you understand what I mean by that? (Bedrail clicks into place.)
If the patient has, you know, biohazard waste
Of course you can put this holder (I took an extra one), it still goes in the sharps container,
this can go in biohazard waste... Needles of course would go sharps container and this would still be trash, okay?
Alrighty. So, thank you! So now I'm gonna leave the patient
and THEIR room.
I am now in the ANTEroom. I'm in the anteroom,
Excuse me, so what I'm going to do, is,
while I'm in the anteroom, I'm gonna reach for
a bag. And you can do inside-out, it's better to do it like this, kind of thing,
You understand what I mean by that?
Okay, so I'm going to take these off. (Simone attempts to remove mask and laughs when it comes apart!)
That one wasn't a very good one! It shouldn't be that hard. A good reason that you don't want to wear earrings.
See how this is tangled up in here? And I can't get it off? It's my fault, so I gotta deal with it.
You guys are not going to be there for me at clinical now, are you! Okay,
...and you shimmy out of that one, inside to out... And that would go...
They'll have like a... Do we have a laundry one...? No.
They'll have a laundry one where you fold that up and put it in the contaminated waste. You understand what I mean?
So now we're at our sink, so I'll go ahead and wash...
--Simone, how long are we supposed to clean the tops of the bottles?--
Oh, man! I didn't my bottle tops! I'm sorry! You gotta clean the tops of your bottles. That would have come
between when I tied the tourniquet and did the
alcohol... --on the arm?-- Yeah, on the arm.
That's where I needed to then go over and clean the tops. --But how long, is it a minute each, also?--
It doesn't have to be for a minute. You're just trying to clean any debris off.
And keep in mind, your tops are going to have
that little plastic sheath over it. --So we pop that sheath?-- Yes.
So they're not... They're sterile, so they're not dirty...
You just want to clean for debris or whatever the case might be...
--Just to be 100%, it's a different swab each bottle?-- Yes, different swab, each bottle, correct. --Okay.--
Okay, so then, you would take your stuff down to the lab.
Now, keep in mind,
I was talking to someone earlier, if you had STAT (short turnaround time) blood draws
or ASAP blood draws, or timed blood draws, for that matter,
but your responsibility
is to handle most of the inpatients for the day
you can things, the STATs in the pneumatic tube system, okay?
Blood cultures are never STAT, because they take
2~3 days to read. But they still want us to draw
it like a STAT, because remember, we can best
isolate the infection when the person has the temperature, right?
So if we're going an hour or two later,
their temperature might be down, so we're not going to be able to isolate
the microbe as much. It's going to take longer for it to grow.
So, no, it's not a STAT, something that we can do, but it's a STAT
as far as drawing the blood, okay?
as far as drawing the blood, okay?