Any nurses out there?

[Thornton]

Re: Any nurses out there?

Primum non nocere.
I urge consideration on 2 levels. Some of the interventions discussed here are dangerous, and the energy devoted to survival in isolation may be a misdirected effort from survival in small communities.
I recommend in finding ways to work a survival strategy with a community.
Unless you have experience, few Americans have the skills or psychological resiliency to survive in isolation. Licensed health care workers and other interested persons can join, lead or start a Medical Reserve Corps unit for more extensive training and exercises.

https://www.medicalreservecorps.gov

Some of those units, with specific leadership, could explore field level interventions. We can also learn from medical missionaries and groups like MSF on how they function with limited supplies and personnel. The dangers we worry about in the abstract for a pandemic are confronted daily by the poor worldwide.
JT

[DRJJ]

Re: Any nurses out there?

I recommend in finding ways to work a survival strategy with a community.
Unless you have experience, few Americans have the skills or psychological resiliency to survive in isolation.

I agree and I plan (am planning) to forge a survival plan in my very isolated neighborhood. But we are spread over several miles. If one of us gets sick, we could set up a sick house or sick RV or some such as an isolation ward and one or more volunteers could help care for them. We only have 1 RN in our community, so this method would allow us to deliver hydration, effectively, with much less work, less training, less equipment, less "staff" and less complications.

I haven't found good instructions yet about the use of hyaluromidase (sp?) to facilitate absorption, but will check out the links provided above.

I also think this is a big prepandemic morale booster....I and my neighbors can provide some of the basics of nursing care despite the absence of access to high tech medical care.

Perhaps I am jumping up and down on the wrong forum, since IV useage is no big deal to nurses, but this fear has been a burden to me, thinking about the sheer amount of nursing hours it would take to hydrate an unc. patient with an eye dropper or spoon or baby bottle. Think about digging a lateral for a septic system with a shovel, versus with a backhoe. This is kind of like 1/2 a backhoe....I need a better analogy, but its 5 AM....

[Kirby]

Re: Any nurses out there?

1) For clarification, this title indicates it is about nurses, but not all nurses are proficient in IV skills. I worked ED for nearly 30 years and started difficult IVs, including IOs on kids in emergencies. However; there are nurses who work in other areas that almost NEVER start an IV. A nurse is not a nurse is a nurse...as most folks think. But I can recommend good ways to find dfficult veins, etc. to any HCW who asks.

X-ray techs start IVs for your CAT Scan or MRI. Lab Techs can use an IV catheter in some hospitals when they draw blood and can initiate the IV line. Point is, in a pandemic, other HCW besides RNs and LPNs will be trained OTJ to do many procedures they don't normally do. If I can give you a little info ahead of time to help, I will do so. I won't tell you how to do a pericardiocentesis or a needle decompression. You can find that on the internet, too and if you need to do that, you are too far down the tubes.

A word of caution about planning to refill used IV bags with homemade IVF: I would not consider that unless I was truly at the very depths of despair and had nothing left to lose. Nonsterile fluids via NG tube or enema into a contaminated GI tract is far less harmful than further jeopardizing a potentally salvagable loved one only to lose them to bacteremia from unsterile IVF. Before I would even consider it, I would spring a $200 bucks for a few more bags of IVF from the website above to stockpile and even use them if they pass their expiration date than try to make my own (sterility not guaranteed past DOE but proven lasts longer than DOE and absolutely safer than kitchen cooked).

Also, don't forget to prep Liquid Tears or some type of eye lubricating drops to wet corneas in your preps for those who get dehydrated, and add an "old fashioned" baby bottle you can actually squeeze (remember how the older kids would squirt each other with the baby's bottle?) or small squirt bottle to frequently spray small amounts of liquid into the mouth if the person is unable to suck. Just be careful not to spray too much at a time and cause choking. Just enough to keep mucous membraines moist and fluid absorb.

*Not planning on practicing medicine; planning on practicing nursing, common sense and motherhood in the face of threat of losing a child.

[Blue]

Re: Any nurses out there?

Actually, the nasogastric and enema routes are a good idea, Kirby. That one RN in the neighborhood, can pass the NG tube. But, I have not seen one in years.
That would be good to have, then you would not need venous or subcutaneous fluids. You would need instructions on the very real safety concerns about the NG tube. These things are possible with some planning and instruction.
We are talking about emergency care in a catastropic situation. Personally, I am glad that we are considering these things. They might really be needed if things get really bad. I would do these things to save a life.
That is a scarey thought that I might need to or that a non HCW might need to ...

[Mojo]

Re: Any nurses out there?

I think that if one does not have skill in starting and maintaining an iv then rectal hydration would be the way to go with the least amt of chance for complications.

I still can't wrap my mind around subq admin of fluids in people. I do it to animals but most have a lot of loose skin which makes it easy. I have seen a lot of bad cases of cellulitis from infiltrated IV's.

Re regular IV's.If you have an elderly patient you could throw them into congestive heart failure if you administer IV fluids too quickly. If careful technique is not used you could introduce bacteria into the bloodstream.There is a lot to know re maintaining an IV including flow rates, site care, etc...

I can get a line in just about anyone. It was one of my lucky skills.
If I had no medical training I would go the rectal route. Just my opinion.

[Blue]

Re: Any nurses out there?

I think that if one does not have skill in starting and maintaining an iv then rectal hydration would be the way to go with the least amt of chance for complications.

I still can't wrap my mind around subq admin of fluids in people. I do it to animals but most have a lot of loose skin which makes it easy. I have seen a lot of bad cases of cellulitis from infiltrated IV's.

Re regular IV's.If you have an elderly patient you could throw them into congestive heart failure if you administer IV fluids too quickly. If careful technique is not used you could introduce bacteria into the bloodstream.There is a lot to know re maintaining an IV including flow rates, site care, etc...

I can get a line in just about anyone. It was one of my lucky skills.
If I had no medical training I would go the rectal route. Just my opinion.

Could you explain a little more about this route. I have never used it for hydration.

I am sure that we can all agree, we do not want to endanger anyone, and we do not want to give any medical advice. Anything we are talking about here, we discuss for dire emergency use only, and if there is no real access to medical care. Our only interest is in saving lives and in giving safe care in a catastophic situation until medical help is available.

[DRJJ]

Re: Any nurses out there?

I planned on the rectal route, but was apprehensive about its suitability if the client has diarrhea. Wouldn't that create a lot of complications that might be very difficult for lay persons with limited access to supplies and hot water and pads, etc. to manage.

The subcutaneous approach calls for a drug which is injected (I think) into the skin to facilitate absorption.

[Mojo]

Re: Any nurses out there?

Here is an article that explores hydration routes for palliative care. It goes into the pluses and minuses of each technique.

http://www.ircm.qc.ca/bioethique/english/publications/JPC/sample/article2.html

I don't know if this flu will have a diarrheal component.

Antidiarrheal meds might be an option and after they start working, small slow boluses of fluid rectally or if the person is unconscious a slow fluid drip rectally might work. I guess you wouldn't know how much fluid would work best till you use it as far as leakage goes. Everyone is different in their ability to retain fluids this way. I am sure adjustments would have to be made till you would find the optimal amt a person could hold without expelling it.

Since I have them here I would probably do an NG tube if I ran out of IV fluids. After that I would go with rectal hydration and then, only if I really really really had to, I'd give it subq and not worry about the Hyaluronidase even though absorption would not be as good. At that point it would be a hail mary kind of thing anyway. Note that certain types of IV fluids are recommended for this type of thing.

I sure hope this thing does not happen and none of this ever has to be used.
These are my opinions and not medical advice, etc.

[Mojo]

Re: Any nurses out there?

Oh and this article is about terminal patients so their ranking of prefered methods reflects that and I am not so sure I agree with it even so.

[Kirby]

Re: Any nurses out there?

My thinking is that if I have to resort to rectal rehydration, the person is already so dehydrated that the gut is empty and diarrhea is not likely to be a major problem. At least not unless you are very successful in rehydration, then you have a better shot at peripheral IV and you won't need rectal route.

For lay person, rectal versus NG, the rectal enema route would be the preferred. I have seen experienced ED nurses traumatize patients with NG tubes and cause bleeding, etc. on occasion. Almost anyone could insert a rectal tube and it would be more comfortable for frequent, small amounts of volume infused. JMO. Applaud Dr. Woodson for being proactive.

If you are having to insert IV fluids at HOME in pandemic for elderly person by inexperienced lay person, surely you have had an experienced person to guide you or referenced some legit info on it if you have IV supplies. If the situation is so dire a lay person is doing IVF at home in the absence of medical care, risk of fluid overload is sort of negated in the interest of saving life to me. We are so accustomed to the idea of the risks versus benefits of our procedures that we forget folks will be doing these things when there are ONLY benefits to it because the person is going to die, anyway in most cases, and they are just trying to do last ditch efforts to save the person. To me, that is where it is OUR responsibility as responsible, professional HCW to help educate and properly instruct anyone who is asking us for info on how to do so at home. My reasoning is that if they are interested in preparing and they think they are competent and willing to prep and learn, we may be the ONLY resource they have to save that person when TSHTF. I want to feel I did what little I could to help anyone that I could and if they are deteremined to do a procedure, they will attempt it, they will whether it is done properly or irresponsibly. Medical TV has shown them alot.

K

[concerned]

Re: Any nurses out there?

Hi, I finally registered after lurking a long time just to reply to this string.

I cannot thank you enough! I am looking at caring for 4 teen-agers (including one developmentally delayed) if this hits.

I have printed out lots of home care stuff and bought a lot of stuff. I was planning on rectal re-hydration if needed and have a lot of info. on it BUT if any of my kids need it while still being conscious I know it would be unpleasant, if not traumatizing, for them.

So, I greatly appreciate all the info. here on other means of accomplishing this.

I bought an Emergency Field Starter Kit for IV on Amazon - it comes with a booklet to help - also bought more supplies for this but I thought the kit would be a good learning tool - I'd make a link to it but I don't know how!

Since I have some first aid training but am certainly no nurse, I so appreciate all your information. Thank you!

[Kirby]

Re: Any nurses out there?

Concerned:

1) I have a teenager and I appreciate your concerns. We've taught airport employees to hook up automatic defibrillators who had no prior medical training because studies showed immediate shocks saved lives of people in sudden cardiac arrest. Drug addicts learn everyday where to locate veins to inject needles to give themselves drugs (I've asked addicts in the ED where there best veins were before I stuck them for IVs or lab specimens - why waste time if they already know?). Why should we be so reluctant to teach responsible folks who want to prepare for what to do for their loved ones in a pandemic when we are being told the medical community may not be able to support the masses? Anyone proactive enough to be on this site asking for info is no drug addict (they learn without the tutorial) asking for personal/illegal gain.

2) The thought of rectal enema rehydration is unpleasant to think about now but in reality, if the kid is so sick that is a real consideration, he/she will be too sick to put up too much of a fuss. It would be more traumatic for the caregiver than physically traumatic for the patient.

[sharon sanders]

Re: Any nurses out there?

Concerned - Welcome.

[cactus]

Re: Any nurses out there?

Hi Concerned,I did the same.

Many years ago, before such things as angiocaths, I put butterflys into fat little thighs, and dripped in fluid.( No pumps either). Yeah, dark ages to you youngsters.LOL.
Anyways,it made those legs bit tight,but didn`t seem to bother the kiddos a bit.Didn`t leave them going very long, just enough to get those kiddos hydrated.
Medicine definately has improved over the past 30 years.

[suzyRN]

Re: Any nurses out there?

Allright guys-great to see so many people involved in this discussion. Been working a lot and witht he holidays i is hard to find time! Thanks to everyone for the info on purchasing iv fluids on the internet- I think the best fluids to have on hand would be normal saline and lactated ringers. Any other ideas? I actually have a lot of expired stuff from nursing school that is still sterile to use. I have no issues with starting an iv in a family member that needed it- though my 4 yr old will definately need restraints!!! I work on a general medicine floor and we do not start our own IVs but I in an emergency I think I could doit. I have done it probably 20 times when I did a preceptorship in the ER. I think it will be great for us to reach out to teach others what we know and form a community plan. I know in my huge subdivision there are several nurses that could man a sick house. As for the govt mandating me to work- If i choose to stay home and help friends and family i am willing to lose my licence. It all depends on the PPE available to me at work and if any one I care about is ill. NG tube would be a great way to rehydraTE as long as you know to check for placement so as not to drown the pt. What other supplies do I need to have available?

Dawn- I think it would be awesome for us locals to start a prep group in the area- what do you think???

Thanks y'all!!! suzy