Peg tube

On Friday I saw a PEG tube placement which was really fascinating. It took a while for the procedure to get started because the patient refused the NG tube for about an hour. The nurse kept trying to put it in and he kept swatting her hand and freaking out. It was really hard to watch. Finally she used something called Hurricane Spray to numb his throat and gel to numb his nose and it went in really fast and he barely knew what happened. She checked the placement by pulling up secretions from the stomach. She told me that she has had nurses put them into lungs before, one time someones lung even got perforated. She said it is scary sometimes b/c some people won't even cough when it goes into their lungs which is amazing. The surgery was so minimally invasive, it was fascinating! There was barely any blood and it was a pretty quick procedure.

Recently I've been doing a lot of nutrition support. I'm getting good with the tube feedings but TPN is still taking me quite a while to do, which my preceptor said is completely normal so whew. I have learned that diprivan is a bitch! One time a patient on the vent was getting over 50% of their calories from diprivan and it was pretty much impossible to meet his protein needs without over feeding him so I just didn't meet them. He was obese and critically ill so it was really hard to feel him adequately. I left a note in the chart for the doc asking if maybe they could try a combo of multiple sedatives, like diprivan +ativan or versed b/c those don't have calories from fat. Nutrition support is fun, like a puzzle, but there is just so much to learn about it, I don't know if I will feel completely prepared even after doing all of these patients, to be doing this on my own completely within the next three weeks before I leave New Bern, but we'll see! I was told by the RDs that my first few jobs will have really steep learning curves, I will be learning much still on the job when I have a real job, so that was helpful to know.