ICU Tip: When in doubt, gown up!

Wow, this has been a pretty crazy week. From heart patients to a massive GI bleed and crazy families to boot. I can say without a doubt I could not be happier that it is the begin of my weekend!

Spoiler Alert: This post might be a little graphic for those that don't appreciate gory details.

I remember in nursing school and when studying for the NCLEX, isolation techniques and universal precautions was a big thing. For some reason I got a lot of those question on my board exam.

"When leaving an isolation room which do you remove first?"

A. Gloves
B. Mask
C. Gown

Uhhh. Whichever has the most blood on it? I have to admit though, the far off voices of my nursing instructors were ringing in my ears this week. You know its going to be a long day when you come in to get report and one of your patients is in trendelenburg, getting three lines placed. He was admitted for persistent nausea, vomiting, diarrhea and an acute drop in his hematocrit. The residents get his central and arterial lines in place and I begin chasing after the eternally long list of orders I have. Three units of packed red blood cells, 2 units of FFP, labs, bolus of bicarb. and the ever so fun job of inserting the foley catheter (for you non-medical folks...take a wild a guess at where this goes and you're probably right). As I'm explaining to him the procedure and setting up my sterile field, he nervously asks, "Have you ever done this before?"

"Oh my dear, I wish I could say I never have, but unfortunately I have inserted more of these than I can count. It's definitely not the highlight of my job." Probably not completely reassuring but its true. Being a nurse in the VA hospital means that 95% of the patients we have are male. I am not a stranger to the male anatomy, to say the least.

Anyways, at this point I am still drastically behind and in the meantime am putting out fires with the family of my other patient. A whole other post in and of itself.

Luckily the nurse who precepted me as a nursing student was my neighbor and was able to help me catch up on stuff. The next thing I had on my list was NGT lavage which I haven't done since nursing school. Diana was nice enough to get everything together while I caught up on charting. In nursing school we were always taught that if there was any possibility of being splashed by any bodily fluid, you wore a gown. Add a mask if necessary. Keeping that in mind, I watch Diana as she begins inserting his naso-gastric tube and my patient begins heaving like mad. I grabbed some gloves and the suction and jumped to try and help save my patient (and my clean bedding of course). This whole time I'm praying that he doesn't start throwing up all over. Of course he does, but luckily it wasn't too bad. Still it was enough to make us realize that the tube we had was too small and would be clogged up to quickly in order to do a lavage.

So here we go....Round Two!
We get a bigger NG tube and I was smart enough to grab two gowns and masks with face shields. I bring them in the room and offer the gown to Diana and she declines. "No, its fine." Huh? Ok, well she was my preceptor at one point....maybe it will be fine?

Could not be more wrong.

Within the next few minutes the patient, the bed, the floor and yes....I was completely covered in old GI blood, and vomit. The worst part. I had short sleeves on, so the space in between my gloves and my rolled up sleeves was completely covered in coffee ground emesis. At this point all I could think was, "Note to self: Next time wear the gown!"
At least my patient and I survived the horrible night and we even laughed about it later. Also, luckily I was smart enough to have recently put an extra shirt in my locker. (Another great ICU tip: always have extra scrubs!)

Just another day in the ICU.