Monday, September 28, 2015

A Tangle of Tubes and Wires

I just know you whippersnapperns have it much more complicated today because I could not even venture to guess all the parameters that you monitor in ICU.  But I bet we have this in common, Don't you just hate it when a new patient is admitted to the ICU directly form the OR?  The anesthetist rattles of a quick report and then quickly heads back to the tiled temple.  You are left with a  rat's nest of wires, tubes, and who knows what else all balled up somewhere on top of or beside the patient.

It's tough to know where to start, but at least you know how a cat feels playing with a couple of balls of yarn simultaneously. This is really a job for more than one nurse. You can draw straws with a couple of discarded needle caps to decide which nurse gets to do the wires and who does the tubing. Wires are  usually the easiest task unless there has been an intra-operative EEG, then both tasks are about equally daunting.

Patience is the key and be sure not to yank on anything to free it up. Try to prioritize, get that arterial line and EKG wires hooked up before you free up that Foley drainage tube. That way you can watch the monitor go wild if you put too much traction on the Foley. At least you know the patient is beginning to react after anesthesia.

This problem is not unique to contemporary whippersnappern's. As this old photo from the late 1940's (that was even before my time!) shows, it requires 5 students and an instructor to untangle this ridiculous hodge-podge conglomeration of tubing and who knows what else. In my time, we would have received demerits for failing to draw the curtain. That spectator gawking in the bed to the left is probably not HIPPA compliant.

It's nice to realize that some problems in nursing remain timeless and serve as a sort of glue to spiritually unite us through time.  These nurses from yesteryear are faced with the same untangling dilemma as nurses today. They might not be dealing with a line from an intracranial pressure screw, but nonetheless go about their task with the same diligence as today's nurse. The sense of caring is always present in nursing.


  1. We dealt with the "terrible tangle" on some of our open heart patients...

    It all depended on who the anesthesiologist and the perfusionist were. Some were great ~ they took away all their extraneous (for us) lines before they brought the patients to the unit ~ others left us with horrible messes to straighten out.

    Nice to know we weren't the only ones!!

    Cheers ~

  2. I think this problem has it's roots in the "get there itis " syndrome. When people are dealing with a critical patient, it is almost instinctive to want to move them quickly somewhere else. Years ago critical trauma patients were tossed into the back of a police car which then raced to the hospital. Thankfully, times have changed, but I still think there is a basic human instinct that says " move this really sick person somewhere else." Maybe it's rooted in feelings of helplessness and that someone at another location could do more.

    Another problem with OR to ICU transfers is finding unexpected things in the cart with the patient. Guide wires, trocars, and other sharp pointy objects might be lurking about so it pays to look where you grab.

    One other thing that used to really bug me was if the patient was lying in a pool of prep solution. That stuff is really hard on the skin. When people are in a hurry, weird things can happen.
    Thanks for your comment.

  3. You can add 3 bottle chest tube suction set ups to that confusion and have a real fun time. Those big glass bottles were always in the way and woe to anyone that accidently kicked one over or pulled out one of the rubber tubes. I remember we had to diagram 3 bottle and 2 bottle chest tube set ups on our state boards.

  4. We had to do the same thing on our boards. When PleurEvacs came into use (about 1971 according to my recollection.) we thought they would never catch on and be in routine use. That bubbling and gurgling noise of the water seal was amplified by the plastic in the PleurEvac. Compared to the old glass bottle set up we thought the noise was very disruptive to patient and nurse alike. Another consideration was our training that to waste anything was sinful. Throwing out that huge chunk of plastic was certainly a mortal sin of the highest order. Breakage of the glass bottles by careless footwork was indeed a constant fear.

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