Nurse oo nurse! venessection of polycythaemic pt

Took care of an intubated patient who's sedation just being stopped for half an hour before. He was drowsy, but when he even cracked a smile - he actually was laughing AT ME - ya, I'm glad for him since that's definitely a good sign. He was waking up for good from induced comatose state.

So what's happen was, I was checking the GCS level & the motor skills. Had him lifting up the hands & legs one by one accordingly. He succesfully moved the hands as instructed, which then I pat the right leg and accidentally spurted, 'angkat tangan ni,' sekali tersasul pulakkk... one of my colleague was there, and we was laughing, together with the patient whose grinning with the ET tube in his mouth! haha.

Apelah ini nurse :D

Anyway eventhough busy with this case, I did learn few new things including polycythaemia (high concentration of red blood cells - Hb) and it's treatment. We had to draw pints of blood (venessection)  usually a pint every alternate day and replace the volume with a pint N/Saline. What's more his blood became so thick that easily clotted, even this causing him to get stroke. He even diagnosed as CVA (stroke) 2° to primary polycythaemia. Dr prescribed hydroxyurea, a cytotoxic medication to subsequently 'deal' with the Hb, then the used of aspirin & plavix to thin the blood.

About the venessection, we actually couldn't get the vennous access for 2 days, so we connected the set to the arterial line. I didnt do it on my small capacity as the incharge nurse some more I still consider myself as junior, but rather my anaesthetist of course. Even so, when he first attempt to jab the set, he gazed at me with a grin. But as I said I consider myself still junior thus I didnt really get along with certain daunted physician, so I pretended not to see that one. :D So we hang the set higher from the heart level on the weighing scale and closely monitor. Still, i got to flush the set few times since it's clotting, and spent my time standing next to the bed from 11am to 3pm (until completed the procedure). Tired, not even touching my paperwork yet, let alone the lunch. Lucky enough I was having double duties that day so I could drag a little to time to topple with it.

p/s: sorry my dear medical staffs if any of you read this entry, I did not utilise the fully medical terms so that others of non-medical line can understand it too :D and sorry for the bad grammar!