Using Ventricular Assist Devices Policies and Procedures

Using Ventricular Assist Devices Policies and Procedures Section 1 – USING VADs II-1 Policy (Section 1) – A. Excepting emergencies, newly placed external or implanted vascular access devices, placement must be confirmed by x-ray prior to infusing any medications or solutions. Note: lines inserted into the femoral vein do not require chest x-ray. B. Administration sets connected to a VAD must be cleaned and prepped using alcohol anywhere along the administration set where entry is made, using a friction scrub for 15 seconds. If the patient displays symptoms of infection: (i.e. febrile, chilling, or has drainage from the VAD exit site), blood and/or site cultures need to be obtained. A physician order is required. C. Emergency care of the VAD includes all of the following: 1. Notify the physician immediately to obtain order(s) if a VAD is cracked, leaking, or has a hole. Clamp the VAD between the site of the defect and the exit site. Clamping must be done atraumatically either with a plastic clamp or with a metal clamp padded with gauze. 2. If the VAD Dacron cuff protrudes from the exit site, secure the VAD with tape and notify the physician. 3. If symptoms of VAD infiltration occur (i.e. edema of the neck, chest, back or abdomen, or shortness of breath), stop the infusion and call the physician immediately. D. For patients who are being treated with antibiotics for sepsis or r/o sepsis, antibiotics ought to be rotated to each lumen of a multi-lumen VAD at least every 24 hours, if possible, i.e. it is optimal to rotate each antibiotic dose, or minimally every 24 hours, until blood cultures are negative for 72 hours. (See Reference Below to II-1-D) E. All central venous access devices which are Present on Admission (POA) or inserted with the intent of the patient being discharged with the device, e.g., hemodialysis, chemotherapy, long term antibiotic therapy, etc. do not require daily validation of medical necessity, but should be inspected for signs and symptoms of infection. All other Central venous devices shall be evaluated for medical necessity on a daily basis. Section 2 – OBTAINING SPECIMENS FROM VADs II – 2 POLICY – (Section 2) – Medical Center A. Aseptic technique is to be used when obtaining laboratory specimens from any type of Vascular Access Devices (VAD). B. Drawing blood from a VAD is performed only by a licensed healthcare professional within their scope of practice using needle-free devices when obtaining or transferring specimens. C. Specimens must be labeled in the presence of the patient and must include patient name, medical record number, date of birth, visit number (for Medical Center only), and date and time of specimen collection. Write the first initial and last name of the person who collected the specimen on the label. Vascular Access Device (VAD), External and Implanted, Catheter Care Page 3 of 17 D. Labs requiring a blue top anticoagulant tube (such as PT/PTT/INR or other clotting studies) should be drawn peripherally. In those instances in which these studies must be drawn through the VAD, this specimen should be the last specimen drawn. E. Syringes less than 10 ml are not to be used when flushing a VAD in order to avoid causing excessive pressure or fracture to the VAD. F. When drawing from a child less than two years of age, a stopcock is used to maintain a closed system and the discard blood is returned to the child within 60 seconds. G. To prevent over-heparinizing a pediatric patient, no more than 50units/kg should be given within a four-hour interval. If flushing does exceed this amount, an MD order should be obtained and individualized for that patient. H. For multi-lumen VADs: When drawing labs from one lumen, clamp other lumen(s) for duration of the blood draw, even if other lumen(s) is heparin locked. This prevents blood from possibly being introduced into second lumen when heparin locked. It also prevents possible contamination of lab specimen if fluid is infusing in second lumen. I. Heparin for routine VAD flushes requires an order in both inpatient and outpatient settings. The dosing and frequency guidelines are found on Attachment C of this policy. II-4 POLICY – (Section 4) – A. An RN who has demonstrated competency in this procedure may perform needle insertion, site care, and needle removal of an implanted Vascular Access Device. B. The surgeon will access the port in the operating room on newly placed ports. C. Sterile technique must be utilized when accessing the implanted VAD. D. Only a 90-degree safety non-coring needle is used to access implanted VADs. Needles are changed every seven days. The recommended non-coring needle sizes for both adult and pediatric patients is 19-22 gauge, 3/4 – 1†. Blood or more viscous solutions require a lower gauge needle. Needle length is dependent upon the amount of subcutaneous tissue and depth of port. Do not access port if area is blistered or there are signs/symptoms of infection. E. Post-op dressings can be removed 24 hours post-op (unless ordered otherwise by physician). Steri-strips at insertion site should remain in place for 7-10 days. F. Implanted VAD site dressing changes are to be done once a week, with the needle change, or whenever it becomes loose, wet, or soiled. G. A heparin-locked non-coring needle may remain inserted for seven days for intermittent IV infusions. If a non-coring needle was placed and the patient does not require therapy, the needle must be removed by an RN prior to the patient being discharged home. H. Topical anesthetics may be used to help minimize the pain of needle insertion.

Primo Levis Survival in Auschwitz Essay -- Primo Levi Survival Auschw

Primo Levi's Survival in Auschwitz Reading the novel Survival in Auschwitz by author Primo Levi leads one to wonder whether his survival is attributed to his indefinite will to survive or a very subservient streak of luck. Throughout the novel, he is time and again spared from the fate that supposedly lies ahead of all inhabitants of the death camp at Auschwitz. Whether it was falling ill at the most convenient times or coming in contact with prisoners who had a compassionate, albeit uncommon, disposition, it would seem as though the Gods were always smiling upon him. Although throughout the novel primo is characterized as a very willing and competent individual, one can not say that his personality or his training as a chemist were the sole factors of his survival. For the purposes of this essay, it is necessary to further address the possibility that maybe Primo Levi was just a lucky guy. The very first lines of the novel support without a doubt the fact that even Levi (Hà ¤ftlinge # 174517) himself is aware of the capacity that luck plays in his life. He begins the novel with the phrase â€Å"It was my good fortune to be deported to Auschwitz only in 1944, that is, after the German government had decided, owing to the growing scarcity of labour, to lengthen the average lifespan of the prisoners destined for elimi- nation† (Levi 9). So, had he been captured prior to 1944, his story might not have been told. Seeing as life in Monowitz (aka Buna or the Là ¤ger) was particularly brutal upon his arrival, one can only imagine the conditions that existed before the Nazi war machine experienced its labor shortage. When compelled to consider the conditions in which Levi was forced to live, it is clear to see that the will to survive must be complemented by another factor, as this will alone is not at all strong enough to sustain life. Not only are the authority figures brutish and sadistic, but the code among the prisoners themselves is even more cutthroat. In addition, the â€Å"cuisine† is terrible and is summed up in the following passage: â€Å"...every two or three hours we have to get up to discharge ourselves of the great dose of water which during the day we are forced to absorb in the form of soup in order to satisfy our hunger†¦Ã¢â‚¬  (Levi 61). Furthermore, the camp is arranged in a hierarchical system with each group of prisoners having corresponding... ...urvivors, how fortunate was he to be among them! Primo Levi’s voice in this novel is so emotionless, that one is forced to jettison all biases regarding the Holocaust until completion of the novel. He does not concern himself with how the reader will look at his role in the story he tells; it is his story, thus the reader need only read and formulate their own conclusions. Because his is the story that so many will never get the chance to tell. He comes off as the quiet submissive type, yet underneath this faà §ade is a very perceptive and clever human being. In fact, the saying â€Å"still waters run deep† just about sums up Levi’s personality. Recalling what was just written of Levi’s personality, it was premature to say that pure luck was the only guiding force in Levi’s survival; some credit must be given to the individual also. So it is of utmost importance to mention that his determination to survive and to provide an accurate, albeit, de tailed account of what he had endured was also a major factor in Primo Levi’s Survival in Auschwitz. Works Cited Levi, Primo. Survival in Auschwitz: The Nazi Assault onHumanity. Trans. Stuart Woolf. New York: Collier-Macmillan, 1987.

Domestic Violence Essay

Before I answer to this question, let me tell you a short story. Her friends describe Maria â€Å"as the perfect girl†. She is beautiful, she is working and she has many friends. However, Maria has many problems in her family. Her father is alcoholic and he is not working to feet his family. So, Maria and her mother are doing two or three jobs each in order to earn enough money to survive. Her father was hitting her and her mother almost everyday. One day one of Maria’s friends that know what it was happening report this situation to the police in order to help Maria. When the police ask Maria if she believes that there are any signs of Domestic Violence in her family, her answer was just like that â€Å"Of course not, no one rape me or my mother or my little brother.† I am here to talk you about Domestic Violence and specifically what it is, how common it is and some basic signs of identifying it in everyday life. In 1993 the Home Affairs Select Committee (HASC) Report on Domestic Violence used the following definition: â€Å"any form of physical, sexual or emotional abuse which takes place within the context of a close relationship. In most cases, the relationship will be between partners (married, cohabiting, or otherwise) or ex-partners†. So domestic violence can affect many aspects of someone’s life. It is more likely to acts against women more than men. Crime survey found that 45% women and 26% men had experienced at least one incident of inter – personal violence in their lifetimes. This means that women affected almost twice as much than men. Domestic violence is repetitive, life – threatening and can destroy the lives of women, children and men. I will be concentrating on how common is domestic violence nowadays. The association for domestic violence prevention in the family was founded in Nicosia on the 25th July 1990. The association is an non- profitable organization. An Administration Body of 9 members also administrates the association. The goals of the association are prevention of use in the family, immediate help to victims in the family, shetter to victims of family members and provide information and generate awareness of the public for the problem of domestic violence. According to the statistics 20% of the murders are due to family violence, generally speaking the police signify two events of domestic violence murders a year. In 2009 8 out of 19 murders are family-violence murders. 85% of murderers are men and 15% are women. 36% of victims are men and 54% are women. We have seen until know how common is domestic violence between sexes but it is very important to highlight some points that can help you to recognize an abusive act or relationship. All forms of domestic violence, psychological, economic, emotional and physical come from the abuser’s desire and control over other family members or intimate partners. Although every situation is unique, there are common factors that link the experience of an abusive relationship. Acknowledging these factors is an important step in preventing and stopping the abuse. This list can help you to recognize if you, or someone you know, are in an abusive relationship. Firstly, is the destructive criticism and verbal abuse like shouting/mocking/ accusing/name/calling verbally threatening. Secondly, the Pressure tactics like sulking; threatening to withhold money, disconnect the telephone; lying to your friends and family about you; telling you that you have no choice in any decisions. Thirdly, when they show to you disrespect for example putting you down in front of other people; not listening or responding when you talk; interrupting your telephone calls; taking money from your purse without asking. Also when breaking your trust, for example lying to you; being jealous and having other relationships. The most serious forms of domestic violence is the sexual and physical violence. Using force, threats or intimidation to make you perform sexual acts or having sex without want it. Punching, slapping, hitting, biting kicking and so on are part of the physical violence. Maria now, knows that the problems that she was having are fall in Domestic Violence. Now she can realize that rape is not only the main cause of it. She and her mother report her father in the police. But even though Maria she is never going to forget what it was happening to her all these years. Further to my analysis of what Domestic Violence is, how common it is and what are the basic signs of it I will show you once again which are the statistics about reported facts of Domestic Violence in the UK. 1. One call about Domestic Violence every minute†¦ 2. 1,300 calls each day†¦ 3. 570,000 every year†¦ After all now you know what Domestic Violence is. Next time you are asked what Domestic Violence is †¦., now you Know the answer.

Charles Wright Mills Essay examples - 1549 Words

C. Wright Mills Charles Wright Mills was a social scientist and a merciless critic of ideology. Mills was born to Charles Grover and Frances Ursula Wright Mills on August 28, 1916, in Waco, Texas. Mills was brought up in a strict Catholic home, but he rebelled against Christianity in his late adolescence. Mills discovered his interest in architecture and engineering when he graduated from Dallas Technical High School in 1934. From 1934 to 1935, Mills attended Texas AM. Here he found himself extremely dissatisfied. Mills decided to transfer to the University of Texas in 1935. This is where he evolved into an extraordinary student. By 1939, Mills was graduating with a bachelors and masters degree in philosophy. He then†¦show more content†¦During his life, Mills had many prominent works Â… New Men of Power: Americas Labor Leaders, White Collar: The American Middle Classes, The Power Elite, The Sociological Imagination, Sociology and Pragmatism, The Puerto Rican Journey: New Yorks Newest Immigrants , Character and Social Structure: The Psychology of Social Institutions , The Causes of World War III ,The Images of Man. Mills remained a nonconformist both personally and intellectually throughout his life time. Mills was married four times. In 1937, he married Dorothy Helen James. During there short marriage, they had one daughter and divorced in 1940. By 1941, Mills was remarried with a second daughter on the way. Six years later, he was divorced again, and ready to move on to his third wife, Ruth Harper. Mills was married to Harper for twelve years before they divorced. Mills final wife was Yaroslava Surmach, the mother of Mills only son. Mills was also an active member of the American Sociological Society, serving as vice president from 1947 to 1948. During the last two years of his life, Mills became a public figure. His tracts against cold War and the U. S. Latin American policy were more widely read than any other radical. As his popularity grew, his Listen, Yankee was featured on the cover of Harpers Magazine. As he was preparing for a television network debate, he suffered a heart attack in December 1960. On March 20, 1962, Mills passed away inShow MoreRelatedCharles Wright Mills : The Sociological Imagination1914 Words   |  8 PagesIntroduction Charles Wright Mills was an American Sociologist whom introduced the model of analysis known as the Sociological Imagination. This model allows us to imagine a connection between our own personal troubles, and larger public issues. In our text, You May Ask Yourself, Dalton Conley gives the example of marriage and divorce (Conley, 2015. Ch. 1). 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This book was poorly received by the sociological community at first, but it is one of the most widely read sociological texts today. The Sociological Imagination and Mills’ other works have had an immense impact on sociology, as he influenced many other scholars and the â€Å"New Left† movement of theRead MoreUnderstanding Sociology s Theory Of Social Self1155 Words   |  5 Pagesdevelopment. As a young child my mom didn’t tell me to go get the broom â€Å"I† simply did that on my own but as I grew up I learned the â€Å"Me† which was an everyday norm. Mead states that we are born with both the â€Å"I† and the â€Å"Me†. The looking glass self by Charles Cooley is related to me anytime I leave my house and I am around other people. I always begin to wonder if I wore the right shoes with my outfit, or does my hair look okay. When I catch someone staring at me I tend to think that my makeup has smearedRead MoreCharles Wright Millss The Sociological Imagination945 Words   |  4 PagesBlaine Rodriguez 9/29/2017 Gen Ed Component 1 In 1959, Charles Wright Mills, who is considered one of the more prominent figures in sociology, published The Sociological Imagination. This work of art is still used by sociologists and taught to many students today. After reading these five pages it gives a whole new meaning to the interactions and behaviors we encounter every single day. It becomes incredibly relevant and advised by Mr. Mills to â€Å"dig deeper† by questioning these scenarios. â€Å"NeitherRead MoreScottsboro Boys Summary1225 Words   |  5 PagesIn the year 1931, all nine of the Scottsboro boys Haywood Patterson, Charles Weems, Clarence Norris, Andy Wright, Ozzie Powell, Olen Montgomery, Eugene Williams, Willie Roberson, and Roy Wright are arrested and tried on charges of assault from fighting white boys on a train. Along with accusations made by Victoria Price and Ruby Bates that the boys raped them. Their trial begins April 6, 1931. All of the boys except for Roy Wright are tired and convicted, with the result of the death sentence, RoyRead MoreThe Historical History Of American Psychology Essay1091 Words   |  5 PagesThe historical underpinnings of American psychology came by way of Francis Bacon and John Stuart Mill philosophy, Charles Darwin evolutionary biology, Chauncey Wright evolutionary psychology, and Wilhelm Wundt volunteer psychology generally (Green, 2009; Wright, 1873). From these philosophical and biological contributors came two majo r schools of American psychology, namely structuralism and functionalism (Green, 2009; Caldwell, 1899; biological terms; see Boucher, 2015, pp. 384-385), which emerged