Donning Sterile Gloves Clinical Nursing Skills

  

A clinical nursing skill registered nurses must learn is how to put on sterile gloves. The nursing  profession is filled with exciting new endeavors for nursing personnel. These individuals have a great responsibility to protect their patients and themselves. For this reason, nurses must learn the sterile technique for donning gloves to protect everyone in the hospital and clinical settings to prevent the spread of diseases and the likelihood of spreading various infections.

 

Introduction on How to Put on Sterile Gloves

 

Those working in the medical profession must master the proper technique to using sterile gloves. Nurses are one of the professionals that use sterile gloves on a daily basis, and they must make sure that they do not jeopardize others with improver glove use.

 

Nurses working in the medical profession are exposed to hazardous materials and bodily fluids. It is important to use sterile gloves to protect others against substances that are harmful. Using gloves that are not sterile is never a good idea.

 

Steps on How to Put on Sterile Gloves

 1.It is important to use proper technique when donning gloves in order to prevent contamination. Unsterile gloves can carry bacteria and other harmful substances that can put nurses and patients in a great deal of danger. Follow these steps to don sterile gloves properly:

 2.Nurses must make sure that they properly clean their hands before handling sterile gloves. Wash hands with warm water and soap before handling gloves. Use plenty of soap when washing from the tips of the hands up to the elbows. Take the hands, arms, and elbows and run them under the warm running water for 15 seconds or more. Repeat the wash and rinse process if necessary. Dry clean hands, arms, and elbows with a clean towel after thoroughly washing them.

 3.Nurses should inspect their gloves carefully before attempting to use them. It is important to look at the gloves for imperfections—such as tears or holes—before using them. Also, inspect the gloves for any signs of moisture that could compromise the safety of the person using the gloves. Throw away any gloves that contain any of the above issues and grab another pair of sterile gloves. Inspect the new pair of gloves in the same manner and proceed before proceeding to the next step in the process.

 4.Now it is time for nurses to don their gloves. After inspecting the gloves, open the sterile pack of gloves with caution. Pick up one glove using the flap of the package containing the gloves. Open the glove and slide it on the free hand. Make sure that the glove contacts only the sterile package.

 5.Using the same sterile package, fold the cuff of the other glove. Pinching the cuff, slide the other glove on using the gloved hand. If the technique is executed correctly, the nurse should not have touched the gloves’ surface with anything other than the sterile glove and the sterile package containing the gloves.

 6.If anything unclean is touched with the sterile glove, repeat the above process to protect everyone involved in the process. Use caution when wearing the gloves so that no contaminates can be exposed to the sterile glove.

 

How to Start an IV | Starting an IV Clinical Nursing Skills



Registered nurses (RNs) learn in nursing school the nursing skill on how to start an IV. A nurse cannot afford not to learn the skill of starting an IV. This particular skill can help patients maintain their health so that they can get on with their lives after receiving medical treatment. Learning how to start an IV properly can extend the lives of patients.


Introduction on How to Start Intravenous Lines (IV)


Nurses must learn how to deliver IV therapy or Intravenous Therapy correctly because if they do not, they are putting the lives of their patients in danger. The process of using intravenous lines involves injecting liquids into the veins. Many nurses use a drip chamber so that air does not enter the patient’s blood stream. IV lines are used for medication delivery, blood transfusions, electrolyte imbalance correction, and fluid replacement. It is so important that nurse know how to use IVs because in some cases the use of IVs is the only way to administer certain medications and to perform procedures such as lethal injections and blood transfusions.


Steps on How to Start an IV


Nurses should use the following steps to start an IV:

1.The first step in the process is to find a good vein to insert the IV. The large vein located in the bend of the elbow is most often used, but nurses can also find good vein sites on the forearm, feet, scalp, hand, and wrist if necessary.

2.Have a fellow nurse prepare the tubing and the fluid bag while the nurse that will insert the IV prepares the sight.

3.The nurse should now apply a tourniquet just a few inches above the site, securing it for easy removal after inserting the catheter.

4.Make sure that the vein is secure and wipe the area with an alcohol pad.

5.Now is the time to choose a catheter size. Children and the elderly generally use a smaller catheter, but an 18 gauge should work for most patients. Nurses should use larger gauges in emergency situations.

6.Carefully remove the cap on the catheter with one hand, and tightly pull the skin around the IV site with the free hand. Keep the catheter as parallel to the skin as possible and insert the needle. A hint of blood in the catheter’s applicator will indicate that the nurse hit the vein directly, and he or she should continue to advance the catheter.

7.While still advancing the catheter, the nurse should now remove the catheter according to the manufacturer’s instructions. Do not forget to secure the needle for the safety of everyone involved.

8.Remove the tourniquet to prevent discomfort and tissue death.

9.Using the fingers, apply pressure to the vein just above the catheter so that back bleeding does not occur.

10.The nurse should now apply tape to the area around the catheter while attaching the IV tubing.

11.Open the IV line and fluid should be dripping into the chamber if the process was successful. Look for leaking and swelling at the IV site. If this occurs, the process was unsuccessful.

12.Additional secure the IV line with additional tape. Nurses should adjust the drip rate accordingly for the patient.

 


 

Indwelling Foley Catheter | How to Insert a Foley Catheter


An important nursing skill nursing students learn in nursing school is how to insert a Foley catheter. The process of inserting a catheter is known as catheterization. Nurses must know how to indwell a foley catheter as one of the many duties of nursing. Inserting a Foley catheter is not an easy process and it involves a great deal of precFsion to perform correctly.


Introduction on How to Insert Foley Catheters


Inserting catheters is a skill that is often used in the medical profession by nurses. Nurses are able to gain access to patients’ bladders and the contents using Foley catheters. Since the catheter can be placed inside the bladder for an extended period of time, it is known as an indwelling catheter. The patient’s urine drains into a bag that is later taken from an outlet device and subsequently drained. Nurses can send the urine samples to the laboratory for further testing for crystals, infections, blood, kidney function, muscle breakdown, and electrolytes. Catheters are also used to treat bladder outlet obstruction and urinary retention in patients.


Steps on How to Inserts a Foley Catheter


Using an indwelling Foley catheter tray, collect all needed supplies.

1.Use two patient identifiers to identify the patient. Discuss all aspects of the procedure with the patient before proceeding. Let first time patients know exactly what to expect from the procedure. Allow time for the patient to ask any questions that he or she may have.

2.Thoroughly wash your hands before coming in contact with materials and the patient to control infection in the facility.

3.Help the patient rest of his or her back and spread the legs for easy access to insert the catheter.

4.Carefully open the catheterization kit, removing the sterile drape and placing it in the procedure area. Before proceeding, place an absorbent pad under the patient to catch any excess fluid during the procedure.

5.Nurses must now apply sterile gloves, open the betadine, and pour it over the cotton balls included in the betadine kit. Carefully remove the plastic that covers the catheter without touching the tube and squirt the jelly on the catheter to lubricate it. Carefully remove the rubber cap on the syringe that contains water.

6.Conduct a test to determine if the balloon inflates or deflates correctly and then attach the included pre-filled syringe to the port and inject all water contained in the syringe. Deflate the balloon without removing the syringe; it must be inflated again after inserting the catheter.

7.Clean the urinary opening of the female patient. Using the non-dominate hand, gently separate her labia. Do not touch anything after this with the unclean, non-dominate hand. For a male patient, gently clean the peri-urethral mucosa with a cleaning solution. Clean the area using one swipe per swab. Make sure to discard the swab from the sterile area immediately.

8.Using the sterile dominant hand, pick up the catheter with a gloved hand. Holding the catheter loosely, insert it into the urethral opening of a female patient. For a male patient, life his penis to a perpendicular position and lightly apply traction in an upward position using the non-dominant hand. Gently insert the catheter one to two inches past where the patient’s urine is located.

9.Using the correct amount of liquid, inflate the balloon (check the balloon size for the correct amount). After inflating the balloon properly, carefully pull the catheter until it is snug against the neck of the bladder. Connect the drainage system to the catheter. Make sure that the drainage bag in lower than bladder level but not on the floor. Carefully inspect the function of the catheter before ending the process.

10.Remove gloves and dispose of them properly. Wash hands again after the procedure. Nurses should end the catheterization process by documenting the size of the inserted catheter, patient’s responses to the procedure, the amount of water contained in the balloon, and a thorough assessment of the urine.



 

How to Draw Blood | Drawing Blood Clinical Nursing Skills for RNs

 

As nurses enter the clinical setting, they will have to know how to draw blood as part of their clinical skills experiences. It may be necessary to draw a patient’s blood for a number of reasons, and it is necessary to draw blood from patients in a manner in which does not cause them any pain or complications.


Introduction on the Purpose of Drawing Blood


There is no way that nurses will be able to get around drawing blood during their clinical skills nursing experiences. The process of drawing blood may look easier than it is, but there is a precise manner in which to draw blood from patients. The process of drawing blood can be very dangerous for patients when their nurse lacks precise blood drawing skills. Taking the proper steps to draw blood protects the health and safety of patients and the nurse assigned to draw their blood. A successful blood drawing begins with a nurse using precision in their blood drawing skills.


Steps on How to Draw Blood

1.Place on a sterile pair of gloves before drawing the patient’s blood.

2.Make sure that the patient is completely comfortable. Ask the patient a series of questions to verify his or her identity. After checking the identifying information against the information provided by his or her doctor, use the identification information to make the specimen tubes before drawing the blood.

3.Gather the necessary supplies (alcohol swabs, tubes, tourniquet, etc.) to draw the patient’s blood and have them ready in the order of their use.

4.Drawing the patient’s blood from the large vein located in the crook of the elbow is the best choice since the vein is close to the skin’s surface. In some cases, nurses may have to choose a vein in another part of the body in order to get a good draw.

5.Tightly place a tourniquet on the patient’s upper arm to prepare the location. Only tie the tourniquet tight enough to make the vein bulge. Pat the vein and find the best location in which to draw blood.

6.Gently and quickly insert the needle into the chosen vein with a smooth motion so that the patient experiences the least amount of pain during the process.

7.Insert the specimen tub into the holder while maintaining the steadiness of the needle. The tube will fill with the exact amount of blood needed for the specimen. Manually pull the back of the syringe to fill the vacutainer with blood if using the needle and syringe.

8.After collecting the last blood specimen, pull out the needle at the exact angle that is was inserted. Immediately apply gauze to the wound after removing the needle and apply a light amount of pressure to prevent bleeding.

9.Dispose of the used needle immediately after using on the patient.

10.Lightly swish the blood in the tubes to ensure that the specimens mix thoroughly.

11.Take one last opportunity to ensure that the blood specimens are labeled accurately before sending the specimens to a lab.


 


Tips on Drawing Blood As a Nurse

Ensure that the last blood specimen tube is removed before removing the needle from the collection site.

Collecting blood from small veins works best using the syringe and needle system.

Ensure that the blood specimens are mixed well after collection to prevent false test results.

Use the butterfly syringe and needle system for elderly adults and children.

Don sterile gloves before making contact with patients and collection tools.

If possible, use a large vein to collect blood specimens.

Use sterile gloves when collecting blood from each patient.


 

What is a Tracheostomy and How to Determine if a Patient Needs Suctioning


A tracheostomy is a process that involves opening the airway of a patient. The goal of this process is to maintain an open airway, prevent infection, and prevent the destruction of the skin surrounding the opening. Nurses must ensure that everything remains sterile during the process to prevent potential infections.


A nurse knows when a patient needs tracheostomy suctioning when the patient is coughing, having difficulty breathing, gurgling, breathing quickly, or making bubbly sounds. The suctioning process should be done before the patients sleeps or eats for the best results. Vomiting may occur if nurses suction patients after eating.


Steps on How to Suction a Tracheostomy

1.Gather all the necessary materials needed for the tracheostomy.

2.Get acquainted with the patient so that he or she is comfortable before continuing.

3.Wash the hands with soap and warm water. Make sure that the clean hands are completely dry before proceeding with the tracheostomy process.

4.Carefully put on a pair of sterile gloves and begin the process.

5.With a gloved hand, grab the catheter at the end that is connected to the suction machine.

6.Allow the end that will attach to the trach tube to remain untouched for now.

7.Before connecting the catheter, the nurse should know how far to insert the catheter before beginning suctioning. Nurses should add ¼ inch to the length of the trach tube to determine how far to insert the catheter.

8.Holding the catheter at the suction depth, attach the suction machine tubing and the catheter and turn on the machine.

9.Do not apply any pressure while placing the catheter inside the trach tube. The catheter should follow the trach tube’s curve. Do not force the catheter and stop at the predetermined measurement.

10.A trach tube that does not pass the catheter may have a blockage inside it so it may be necessary to add saline and resume the process. If the process fails a second time, it may be necessary to change the tube and start the process again.

11.Use the forefinger and the thumb to pull out the catheter. While retracting the catheter, use the thumb to apply a light amount of pressure to the whole in the catheter.

 

Colostomy Care | How to Change a Colostomy Bag



Patients who have colostomies have lost the ability to pass feces from their rectum, due to this nurses have to learn how to provide colostomy care. One of the things a nurse should know about providing colostomy care is how to change a colostomy bag. Many of the jobs assigned to nurses are not glamorous, but someone has to provide these services to help patients in need. The colostomy is a surgical process that can be irreversible or reversible depending on the unique situation of each patient. Nurses help to make a difference in the lives of patients who require the insertion of a stoma through a process known as a colostomy.


What is a Colostomy & How to Change a Colostomy Bag


A colostomy is a procedure that allows patients an alternative manner in which to rid their bodies of feces. Patients undergo a colostomy when their colon has been removed or a section of the colon requires a time to rest while it heals. The surgical procedure uses the healthy end of the colon or large intestine to form a stoma. The colon or intestine is pulled through an incision in the abdomen and held in place by a surgical suture. Patients may undergo a double barrel colostomy, loop colostomy, or end colostomy.


A colostomy bag is used to collect the flatus and feces from the patient’s stoma. The waterproof bag sticks on the patient’s abdomen so bathing and showering are not a problem. Patients can either have a stick-on type or strap-on type colostomy bag. The most commonly used type of colostomy bag is a stick-on type because it is the more comfortable of the two bags.


Steps on How to Change a Colostomy Bag

1.Wash hands before beginning the procedure.

2.Gather the necessary materials to change a colostomy bag. The materials include soap, stoma paste, washcloth, colostomy clamp, razor, scissors, and stick-on colostomy bag.

3.Gently wash around the stoma using a warm soapy washcloth. Pat the area dry after cleaning. The washing process helps the bag stick and keeps the area around the incision sanitary.

4.Using the razor, shave the hair within two inches of the stoma. This process alleviates a great deal of the pain caused from removing the sticky bag, and this process is done for sanitation reasons.

5.Look inside the box containing the new colostomy bag. Use the cardboard holes on the box to size the wax according to the particular that will be stoma used. Select the one that fits snuggly around the patient’s stoma.

6.Use scissors to cut away the extra wax at the end of the colostomy bag. The cardboard can be used as a guide if needed.

7.Carefully remove the adhesive and place the colostomy bag around the opening of the stoma. Use a thin layer of stoma paste around the outer edges of the wax to seal out any type of moisture. Using too much stoma paste may prevent the wax from sticking properly.

8.Clamp the open area near the bottom of the colostomy bag. The opening on the bottom of the bag makes cleaning and emptying easy, but it must remain clamped in between these times to prevent leaking of the contents.


 

Intramuscular Injection | How to Give an IM Injection

 

A nurse, while in nursing school, learns how to give IM (intramuscular) injections. Nurses must prepare to handle many different types of medical care for patients of all ages. One of the many procedures that nurses perform is the intramuscular injection (IM). The process can be very painful if not conducted in the proper manner. Serious medical issues can arise if intramuscular (IM) injections are not performed correctly. It takes a great deal of skill and practice to perform intramuscular injections on patients so nurses must get all the practice that they can in order to master this nursing skill.


How to Give Intramuscular (IM) Injections


Intramuscular injections are part of medical procedures in which medications are injected directly into the muscles. There are certain medications that can only be administered from injections into the patient’s muscles. Depending of the amount or type of medication, intramuscular injections may be necessary. Intramuscular injections are provided for patients who need fast acting medications administered to them.


IM Injection Sites


There are 4 sites that are perfect for intramuscular injections. The best locations to administer intramuscular injections are the:

Dorsogluteal Muscle

Deltoid Muscle

Ventrogluteal Muscle

Vastus Lateralis Muscle


Selecting the best site is important to prevent injury and proper absorption of the medication. Large muscle sites with little fatty tissue are the best sites for intramuscular injections. Palpate the muscle prior to administering an injection to ensure the muscle is able to support the medicine to be administered. Medical professionals may suggest a particular site to patients so that they experience the least amount of pain during the injections.


Intramuscular injections can be performed using 18-23 gauge needles. For viscous and large amounts of medication be sure to use larger needles. It is possible that patients will faint during the injection process so nurses should take precautions to prevent any type of injury to the patient while administering the intramuscular injection.


 

Wet to Dry Dressing | How to Change a Wet to Dry Dressing Clinical Nursing Skills



It is very important that nurses have the skills to attend to the wounds of a patient by mastering the skill of wet to dry dressing. Clinical nursing skills can encompass a wide variety of skills in order to help patients. There is no such thing as a small job or responsibility when it comes to nursing because no matter what nurses do, they are helping their patients get well and regain their independence. There are many medical conditions in which wounds can be the end result. Nurses must always maintain a safe environment in order to prevent the spread of infection.


Introduction on Use of Wet to Dry Dressings


Some wounds heal on their own without the need for dressing to help them heal. Others require a dressing to allow them to heal properly and keep out elements that can cause the wound not to heal properly. The wound’s dressing allows the dead skin cells to collect in the dressing so that the wound can heal effectively. The wet to dry dressing change is an effective way to help wounds heal properly because the process allows a nurse to evaluate the wound for the signs and symptoms of various types of infections. The patient’s doctor will determine a schedule for the changing of wet to dry dressings.


Steps on How to Change Them

1.Check the patient’s chart to make sure that a wet to dry dressing is what the doctor requested. Make sure that the change is in accordance with the established schedule.

2.Gather the materials needed to perform a wet to dry dressing. The materials include paper tape, sterile gloves, sterile solution, and 4-by-4 gauze. Ensure that all materials are available before moving forward with the process.

3.Wash from the fingertips to the elbow using soap and warm water. After thoroughly washing the hands and arms, put on a pair of sterile gloves before beginning.

4.Make sure that the patient is comfortable before proceeding. Discuss the process with the patient before beginning, and answer any questions that he or she may have.

5.Begin the process of removing the dressing by starting along the edges and bunching the old dressing to the center of the wound. Dressing may be stubborn on severe wounds so it may be necessary to use sterile saline to loosen the dressing. Allow the saline to sit for a while to detach the wound from the dressing before continuing the removal process.

6.Thoroughly clean the wound using saline and 4-by-4 gauze. It is important to use a light amount of pressure to the wound so that the new skin is not disturbed while cleaning the area.

7.Using a piece of 4-by-4 gauze, lightly pat the wound until dry. Carefully inspect the old dressing, noting the odor, color, and consistency.

8.Before applying the new dressing, assess the patient’s wound very carefully. Make note of any signs that the wound is not healing properly.

9.Use sterile solution to moisten half of a few pieces of clean 4-by-4 dressing. The number of pieces of sterile gauze depends greatly on the size and severity of the wound.

10.Place the moistened gauze directly on the patient’s wound and follow with dry dressing.

11.Secure the dressing with paper tape. Evaluate the security of the dressing and apply more tape or gauze as needed.


 

Tips on Changing a Wet to Dry Dressing

Maintain a sterile setting by washing hands before and after dressing changes.

Always check the patient’s charts to ensure the doctor ordered the dressing change. It is possible to cause additional medical issue by applying wet to dry dressing to certain wounds.

Disposed of all old supplies and dressing in the appropriate areas to maintain a sterile environment.

Use caution when removing old dressing because a new wound can delay the healing process of an existing wound.

Any signs of infection, tissue loss, or excessive bleeding should be reported to the physician immediately.


Complications with a Wet to Dry Dressing


Infections can occur in wounds that are not properly dressed. Dressing wounds at times other than those outlined by a physician can lead to infections. Pulling the old dressing that is attached to the skin can result in additional wounds and possibly infections that can prolong the healing process.


Changing wet to dry dressing is a skill that nurses must be proficient in to help their patients. There are so many things that can go wrong in the quick process that can threaten to cause infections in patients. Nurses have the power to help their patients maintain the care of their wounds so that they can heal properly.

 

Nurses can minimize the pain that their patients experience during injections by doing the following:

 

Never reusing needles

Injecting medications once they’ve reached room temperature

Break the skin quickly

Remove air bubbles from the syringe before administering the injection

Use the same direction when inserting and removing the needle from the skin

Relax the muscles near the injection site



 

Complications from Giving a Subcutaneous Injection


There are minor complications that can take place during a subcutaneous injection. Patients may experience soreness, redness, or bleeding at the injection site that will go away in a short amount of time. Some patients may experience allergic reactions to medications administered through subcutaneous injection so it is important to check the patient’s allergies before giving the injection. At times, patients may experience blood in the solutions, and nurses should select another injection site to give the subcutaneous injection.


Nurses can easily master the skill of subcutaneous injection with practice. Experienced nurses know how to minimize the pain that their patients experience by using care when administering subcutaneous injection.


 

Tips on How to Take a Blood Pressure

 

Make sure to use the correct size cuff to take the patient’s blood pressure. Use the widest part of the patients arm as a guide. The cuff should be at least this wide.

Patients should not exercise, eat, or smoke at least 30 minutes before having their blood pressure taken.

Measure the blood pressure in the same arm if taking readings daily.

Measure the blood pressure at least twice to ensure accuracy of the reading.


How to Interpret a Blood Pressure Reading


Interpret the blood pressure reading by placing the systolic number over the diastolic number. For example, if the systolic number is 120 and the diastolic number is 80, the reading will be 120/80. 120/80 is consider an optimal blood pressure reading while 130/85 is normal blood pressure. A doctor should closely monitor any systolic reading between 130 and 139 or diastolic reading between 85 and 89.


Nurses have many responsibilities to their patients. Taking the blood pressure of patients is one of the most important things that nurses can do for their patients because monitoring blood pressure readings can save the lives of patients.

 

PICC Line Care | PICC Line Dressing Change Clinical Nursing Skills

 

Many patients require the use of a peripherally inserted central catheter (PICC) as they continue to heal. Doctors, nurse practitioners (or physicians assistants) insert PICC lines for patients who need IVs for a certain amount of time. These long lasting IVs are much better for patients than the traditional IVs. Nurses must make sure that the dressing on a PICC line is always clean and free of debris. This is a very important nursing skill that will become more and more important as PICC lines are used more and more often in the medical industry.


What is a PICC Line


A peripherally inserted central catheter or PICC line is a soft plastic tube that is inserted into a large vein right above the patient’s heart. The PICC line must remain sterile at all times so that the patient does not run the risk of getting an infection.


How Often are PICC Line Dressings Changed


PICC lines should be changed at least once per week. If the dressing becomes loose, wet, or dirty, the dressing must be changed more often to prevent infection. PICC line dressings must be inspected on a daily basis. Moist dressings are breeding grounds for infections. Signs of moisture, wetness, or dirt are signs that the dressings need to be changed more often. Loose fitting PICC line dressings can make it possible for dirt and debris to enter the area around the insertion site.


 

PICC Line Removal | How to Remove a PICC Line | Clinical Nursing Skills

 

Nurses must make sure that a PICC line remains functioning properly and that the dressing around it remains sterile. PICC lines are catheters that help patients maintain their good health. At some point, patients must have their PICC lines removed so that they can continue to maintain their good health. Nurses must be prepared to remove PICC lines in the safest manner possible. This is an important nursing skill that be performed on a frequent basis for most nurses.


What Is A PICC Line?


A peripherally inserted central catheter or PICC line is small, long, flexible, slender tube that nurses insert into a patient’s peripheral vein. The insertion usually is in the upper arm area. The PICC line usually advances until the tip of the catheter ends in a large vein in the patient’s chest near their heart to gain access intravenously.


Steps on PICC Line Removal


When patients no longer need their peripherally inserted central catheter, it must be removed. Registered nurses qualified to give intravenous medication are the only nurses who can remove PICC lines. This painless procedure takes a few minutes to complete by a trained nurse.

1.Gather the necessary materials to remove the PICC line. The materials include sterile scissors, sterile dressing packages, stitch cutter, air occlusive dressing, hibitane solution, and sterile gloves.

2.Wash the hands thoroughly and put on a new pair of sterile gloves before proceeding.

3.Take a few moments to explain the PICC line removal process to the patient. Answer any questions that he or she may have about the procedure.

4.Organize the materials near the patient’s bedside before performing the procedure. Turn off the infusions and prepare the dressing patch before positioning the patient.

5.Place the patient in the supine or Trendelenburg position to remove the PICC line.

6.Using the stitch cutter, carefully remove the suture that holds the central venous catheter. Hold the suture in a manner that ensures that it does not migrate accidentally.

7.Prepare the patient for the next step by asking him or her to hold the breath as the nurse removes the catheter. Cover the area immediately with sterile gauze and hold the gauze in place with a light amount of pressure.

8.While the patient is still holding his or her breathe, cover the area with an occlusive dressing. Reposition the patient once the process is complete. Tell the patient that it is okay to stop holding his or her breathe.

9.It is necessary to document aspects of the procedure. Use the progress notes to document the date, time, type, and condition of the catheter at the time the central line was removed. Also, make notes on the condition of the patient. Chart conditions such as discharge, swelling, and redness of the patient’s skin.

10.The nurse should monitor the patient for the next 24-48 hours following the procedure. The dressing should remain in place for 24-72 hours, according to the timeframe in which the catheter was in position. Closely watch the patient after the removal for signs of infection, bleeding, and air embolism.


 

How to Take a Pulse | Taking a Pulse Clinical Nursing Skills

 

Patients may need to have their pulses taken for a variety of reasons. The most common reason patients have their pulses taken is because they have a medical illness, such as heart disease. Nurses must keep a record of their patients’ pulse rate to make sure that they are in good enough condition to take medications or receive certain medical treatments. It is important that nurses can quickly check the pulse rate of patients so that doctors can provide them with the proper medical care.


What is a Pulse & Normal Resting Heart Rate?


A person’s pulse is his heart rate. In other words, the pulse is the total number of beats the heart makes in one minute. A person’s resting heart rate is the pulse when at rest. A normal adult’s resting heart rate is approximately 60 to 100 beats in one minute.


Pulse rates vary greatly from person to person. Heart rates rise when people take part in certain activities or take certain medications. The following are factors that influence heart rate: emotions, fitness level, body size, activity level, medication use, body position, and air temperature.


Arteries that are close to the skin provide the best opportunity to feel the pulse. Several arteries in the body are used to find a pulse. The most common arteries for feeling the pulse are the carotid, apical, and radial.


Types of Methods Used to Count Heart Rate

Karvonen Method- This method uses a person’s resting heart rate to calculate the target heart rate, using an intensity range of 50-85%.

Zoladz Method– This method creates exercise zones by subtracting certain values from the patient’s maximum heart rate.


How to Check Your Pulse


Apical Pulse:

A stethoscope is placed over the patient’s heart to get a pulse. Nurses should have a watch that has a second hand to take an apical pulse. The following offers steps in which to take to find a patient’s pulse:

Have the patient to lie down or sit up to have the pulse taken.

Place the buds of the stethoscope in the ears and place the disk portion over the patient’s heart.

After hearing the heartbeat, count the number of beats for 60 seconds. Use a watch with a second hand to take the pulse. Listen for a weak, missed, or strong heartbeat.

Record the pulse rate, time, and date the pulse was taken. The nurse should take note of any issues with the pulse rate.


Radial Pulse:


Nurses can locate the radial artery inside the patient’s wrist close to the thumb. Count the patient’s pulse using a watch with a second hand. Use the following steps to get a radial pulse.

Ask the patient to place the arms at his or her side and bend the elbow with the palm facing an upward position.

Find the pulse of the patient’s radial artery by using the index and middle fingers. Never use the thumb to find the patient’s pulse because the thumb has its own pulse.

Count the pulse for 60 seconds and pay close attention to the strength of the beat.

The nurse should write down the patient’s pulse rate along with the time and date the pulse was taken. Also, write down the wrist in which the pulse was taken.

The radial artery offers an easy manner in which to check the patient’s pulse.


Carotid Pulse:


Nurses can locate the patient’s carotid arteries on the left and right outer portion of the patient’s neck. Use a watch with a second hand and follow these steps to take the patient’s pulse.

Find the patient’s pulse on the right or left side of the neck by using the index and middle fingers. Use only one side of the neck to take the pulse.

Once the patient’s pulse has been located, count the pulse in the carotid artery for one full minute.

Write down the patient’s carotid pulse along with the time and date taken. Pay close attention to a weak or strong beat and make note of anything noticed in the patient’s file.





Nurses have a variety of options when it comes to taking a patient’s pulse. Most nurses use a stethoscope to locate the patient’s apical pulse. Additionally, nurses may use the carotid and radial arteries to take the patient’s pulse rate. Nurses must be able to locate the patient’s pulse very quickly because it is a part of any doctor’s visit. Learning the nursing skills of taking a patient’s pulse will come easy with experience.

 

Nasogastric Tube Insertion | How to Insert a NG Tube | Nursing Clinical Skills

 

The process of inserting an NG tube has its risks, but once nurses gain experience in this area, they should be able to insert an NG tube without any level of difficulty. It is important that nurses know the reason that their patient has an NG tube in order to avoid any pitfalls that can occur as a result of the procedure. Therefore, nurses should seek to master this nursing skill.


What is a Nasogastric (NG) Tube?


Nasogatric (NG) tubing is a procedure that nurses use for diagnostic and therapeutic purposes. Patients have an NG tube inserted immediately after any major surgery for approximately 48-72 hours. An NG tube is intended for short-term used to help prevent vomiting after surgery and to keep the patient’s stomach empty. Nurses also use the tube to feed critically ill patients and to administer their medications to them. Nasogastric tubes are also used in the event of drug overdose, aspiring the patient’s gut when GI bleeding occurs, and gathering gastric content from the patient’s stomach for lab analysis.


Steps on Nasogastric Tube Insertion

1.Wash the hands thoroughly and dry them before donning sterile gloves. Gather the following materials: suction, non-allergic tape, NG tube (rubber or plastic), towel or protective pad, water-soluble lubricant, rubber band, 60cc irrigating syringe, gloves, stethoscope, curved basin, and safety pin.

2.Explain the procedure to the patient and answer any of their questions before moving forward with the procedure.

3.The nurse should now position an unconscious patient in a lying position on the left side of the body, and position a patient who is awake in a sitting position.

4.To minimize the possibility of aspirated gastric content from coming in contact with the patient, place a towel or protective pad over the chest of the patient.

5.Using the NG tube, measure the length from the earlobe to xiphoid process and from the nose to the earlobe to determine the length that the NG tube must be.

6.After adding the two measurements together, use a piece of tape to mark the total distance on the tube.

7.Inspect the patient’s nostrils for obstructions. An alert patient may need to blow the nose to clear the opening.

8.Use a water-soluble lubricant to lubricate the NG tube’s first six inches. Use the nostril with the largest opening to insert the NG tube down the back of the nostril to the nasopharynx.

9.Ask the patient to swallow once the tube enters the pharynx. If the patient is not able to mimic the swallowing action, ask the patient to sip water. An alert patient should place the chin on the chest to aid the tube’s passage. Continue directing the tube until it reaches the location marked by the tape.

10.Verify that the tube is in the stomach by performing two of the following options: submerging the tube’s open end into a cup of water (bubbles indicate the tube passed down the larynx); chest X-ray; request that the patient talk or hum (choking and coughing means the tube passed down the larynx); use the irrigation syringe for aspirating gastric contents; or use a stethoscope to listen over the patient’s epigastrum while using an irrigation syringe to instill a 30cc air bolus ( a whooshing sound indicates that air entered the stomach).

11.If it is not possible to confirm that the NG tube is in the stomach, the nurse should remove the tube immediately and try again.

12.After confirming the placement, secure the tube with tape by wrapping one end around the tube and placing the other end at the tip of the patient’s nose. Make sure the nose is prepped and clean before applying the tape.

13.Connect or clam the NG tub if desired. When using a Salem sump tube, make sure that the blue pigtail remains at the level of the fluid in the patient’s stomach or leakage of gastric contents may occur.



 

NG Tube Placement | How to Check Nasogastric Tube Placement | Nursing Skills


Nurses must learn to place nasogastric tubes into patients correctly so that they can receive the medical services that they need. Even seasoned nurses who have mastered the skill of nasogastric tube placement must follow certain measures to verify the placement of the tube. The verification methods are a relatively easy clinical skill as long as nurses follow certain measures.


Importance of Correct Nasogastric (NG) Tube Placement


Nasogastric tube placement is important to patients for a number of reasons. One reason is that that the tube can release liquid and air contents from the stomach of the patients. Those suffering from gastric or intestinal obstruction must have their NG tubes placed correctly to prevent the patient from vomiting the contents of the stomach. Proper placement of the NG tube is also important to patients suffering from strokes or tracheotomies because it is a useful tool for feeding the patients.


Methods Used to Check Correct Placement of Nasogastric (NG) Tube


Nurses can check the placement of the patient’s NG tube by using one of the following methods:

Chest X-ray – This method offer one of the best ways to check the placement of the NG tube. The method is generally uses for confused patients and those in the Intensive Care Unit as well as patients with swallowing issues. The nurse X-rays the upper portion of the patient’s abdomen, looking for an opaque, white line on the left side under the diaphragm.

Syringe test – This method is not uses very often anymore. The syringe test or “whoosh test” checks the placement of the tube by using a stethoscope to listen for the whooshing sound as a syringe instills a 30cc air bolus in to the patient’s stomach.

pH test – This method aspires the NG tube and checks the content by using pH paper. If the ph is 5.5 or higher, the tube has be properly placed.