Do you ever get tangled up?

[medicdan]

As I gain more expierence, I have been working on an ALS bus quite a bit. I have learned a lot about the ALS equipment, and now feel pretty comfortable assisting with it's usage, but I have one lasting problem...

On many ALS calls in my region, almost all patients get a EKG (either 3 or 12 leads), and inevitably are monitored for PulseOx, BP, etc, and many get O2 and/or an iv and bag to be hung. Whether we do this monitoring in the ambulance or on scene, I always seem to get my wires (and tubes) tangled. I am often the one attaching everything (while the paramedic and MD are interviewing or prepping interventions). I have tried everything I can to keep it all clear, and still end up detangling the patient when we get to the hospital.
What do you do? Is there a key trick I am missing? Do you not leave the monitor on most patients? I inevitably end my shifts with my pockets filled with the little plastic pieces from the madbekot (stickers).

I would love some insight on this very basic skills that I have yet to master.

Thanks
DES

 

[Epi-do]

If anyone has a way to keep the monitor wires from getting tangled, I would be forever indebted to them if they would share them!

I think that is just part of it. I do my best to untangle them before putting them back in the monitor case, but always have to still untangle them a bit when getting them back out to put on the next patient. Depending upon what exactly is going on with the patient, the reasoning that led to using the monitor, and how the patient's condition has changed during transport, sometimes the medics I work with will d/c the monitor as we are pulling into the bay at the ER. That way we don't have to mess with the wires at all while moving the patient. Other times, the monitor is removed immediately before moving the pt from our cot to the ER bed. When the run is all said and done, the wires still need to be untangled.

Murphy's Law also dictates that all IV tubing and O2 tubing will also get tangled within the monitor wires. That doesn't seem to happen as often though. It seems to be more common when you have three different people doing three different things to/for the patient. Just do the best you can to keep things from getting tangled and realize that despite your best efforts it will still happen.

 

[KEVD18]

easy. one thing at a time. direction direction direction. where is the o2 fitting in the truck? off the pt right shoulder. so the o2 device goes that direction. the monitor, while it can be in a few place during transport, when you pull the stretcher out where is it? on the back of the stretcher or, if you have one that hangs off the side rail its there. either way, have the monitor cable exit the pt towards their left(since it sort of leads in that direction with a XII lead anyway. where does the iv line go? in the rig, straigh up. sound good to me, lets not change that. when you got to pull em out, clamp the line, unhook the bag and put it behind their head or even on their lap.

so now you have the o2 line coming off the right shoulder to your portable on the back.

the monitor line comes out the left side.

and the iv line lands right in the middle.

when you get to the er bed, local and personal preference will dictate how to proceed, as well as acuity of the pt. if they were being monitored prophalactically(sp?) they can probably stand to be off the monitor for a minute. i find it easiest to unplug the lead wires from the lead wire junction( i may have made that up, but the junction where the III and XII join). d/c the o2 and transfer the pt. just make sure to get your lead wire back. you normally dont have a spare so this isnt a good thing to forget. or, you can d/c the monitor entirely before the transfer.

the main point is keep track of things as you go along and keep them seperate.

who do you work for in the boston area if you dont mind me asking.

 

[medicdan]

Thanks for the advice... I will be more careful of what direction the various lines go. I think the problem originates from the services I work with not having a way to attach the monitor to the bed. Essentially one of the crew needs to carry the monitor or put it at the patient's feet (I dont like doing that). While the monitor may be at the feet during movement, the monitor shelf is up and to the right of the patient's head in the ambulance.
When in MA, I ride with a small volunteer service in western MA and work as a first responder at a music venue in western MA.
Most of my expierence comes from working with Magen David Adom in Israel-- the national ambulance service-- the sole provider of emergency care in the country. i was there for two months, came back to the US and hope to go back in May (to become an instructor and teach). A lot is done differently in Israel, and thru comparing the two systems I learn a lot.

In September I am going to be going to go to school in the Boston area and hope to volunteer for the on-campus EMS and maybe work for a surrounding neighborhood's ambulance (AMR).

 

[KEVD18]

for the love of all that is good and holy not another good emt candidate lost to the dregs of the three letter wonder. take it from me oh young padewan(sp?) i worked for amr in this area. dont. i'll tell you everything i know about every company in the metro area offline. ive worked for a few of them and between me and my friends we've worked for all of them and i can give you info you may not get elsewhere. good, bad or indifferent, i'll tell you everything i know. feel free to pm me if you want the poop about any one company.

but thats about the only piece of advice for the tangled mess of cables thing i got for ya..

 

[Ridryder911]

Actually there is a commercial brand wire detangler. I too have have problems with too many lines and too many wires. I have found if possible to place the cables up towards the shoulders and clip it to the sheet. Unless necessary, I eliminate IV's especially if it is only for KVO rate, SL the IV off and one less tubing. I also mark multiple tubing with tape tag, for different med.'s so in case I need to control it.

If I want to leave the XII on for serial ECG's or for it to detect ST segment changes, then I will attempt to place the cables towards the pelvis area.

I thought of different ways to solve this problem especially in ICU/CCU where patients become even more entangled from turning over. Some of them have worked, but patent and research is expensive.

R/r 911