Educational Resource Blog FOR and about Nursing...
Sunday, July 17, 2011
Thursday, July 14, 2011
What is a Tracheostomy?........
A tracheotomy or a tracheostomy is an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy tube rather than through the nose and mouth. The term “tracheotomy” refers to the incision into the trachea (windpipe) that forms a temporary or permanent opening, which is called a “tracheostomy,” however; the terms are sometimes used interchangeably.
Airway Problems That May Require a Tracheotomy
The superior thyroid notch, cricoid and suprasternal notch usually can be easily palpated through the skin. The cricothyroid space can be identified by palpating a slight indentation immediately below the inferior edge of the thyroid cartilage. Cricothyroid arteries traverse the superior aspect of this space on each side and anastomose near the midline.
The innominate artery crosses from left to right anterior to the trachea at the superior thoracic inlet. Its pulsations can be palpated and occasionally seen in the suprasternal notch especially in case of a high riding vessel, representing a contraindication for a bedside percutaneous or open tracheostomy.
The isthmus of the thyroid gland lies across the 2nd to 4th tracheal rings and must be dealt with in any procedure at or around the upper trachea.
Our approach includes the following equipment and protocols:
The technique described here is based on Seldinger’s principle 2. The technique we use was first described and later modified by Ciaglia 3. The use of bronchoscopy was first introduced by Marelli et al and has subsequently been adopted by many centers 4, 5.
Positioning
Introduction of Guide Wire, Stylet and Initial Tract Dilatation The needle is withdrawn while keeping the cannula in the tracheal lumen. A J-tipped guide wire is then place under vision. The stylet is then placed with the safety ridge directed towards the tip of the wire. The tract is then dilated with the 8 FR dilator.
Dilatation with the Blue Rhino Dilator The Blue Rhino dilator is loaded on the stylet with the tip resting on the safety ridge. The dilator is moved in and out to optimally dilate the tissue between the skin and the tracheal lumen. The Blue Rhino dilator is never advanced beyond the point where 40 FR mark disappears below the skin level.
Placement of the Tracheostomy Tube
The bronchoscope is withdrawn from the ETT and introduced via the tracheostomy tube. The placement is confirmed by visualizing the carina.
Securing the Tube
We routinely secure the tube with 2 sutures of 2-0 nylon on each side of the flange. In addition, a tracheostomy tape is used to hold the tube in place. A flexible extension tube is used to connect the tube to the ventilator circuit to avoid undue movement of the tube in the immediate postoperative period.
The tract between the skin and the tracheal lumen takes a little longer (10-14 days) to mature as there is no formal layer by layer dissection involved. We, therefore, perform the first tube change on Day 10-12 postoperatively.
Percutaneous dilational tracheostomy (PDT), also referred to as bedside tracheostomy, is the placement of a tracheostomy tube without direct surgical visualization of the trachea. This is considered a minimally invasive, bedside procedure that may be easily performed in the intensive care unit or at the patient’s bedside – with continuous monitoring of the patient’s vital signs.
Two critically important preoperative criteria for PDT are:
Although there is a learning curve to the technique of PDT, it is relatively easy to learn. The learning curve may be overcome by performing a number of supervised procedures. Other advantages include:
As with any surgery, there are some risks associated with tracheotomies. However, serious infections are rare.
Early Complications that may arise during the tracheostomy procedure or soon thereafter include:
Over time, other complications may arise from the surgery.
Later Complications that may occur while the tracheostomy tube is in place include:
Delayed Complications that may result after longer-term presence of a tracheostomy include:
A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator. The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted.
There are different types of tracheostomy tubes available and the patient should be given the tube that best suits his/her needs. The frequency of these tube changes will depend on the type of tube and may possibly alter during the winter or summer months. Practitioners should refer to specialist practitioners and/or the manufacturers for advice.
Tracheostomy care/suctioning
Stoma care
Tracheostomy equipment
Tracheostomy equipment cleaning and care
Eating with a tracheostomy
Speech with a tracheostomy
Tracheostomy as a Passey Muir Valve
Suctioning a tracheostomy
Traveling with a tracheostomy
Swimming with a tracheostomy
Tracheostomy Humidification
Decannulation
Professional Organizations
American Academy of Otolaryngology - Head and Neck Surgery
American Association for Respiratory Care
Resources for Nurses Caring for Patients with a Tracheostomy Society of Otorhinolaryngology and Head-Neck Nurses, Inc. (SOHN)
AAOHNS Conferences and Events
Support Group
Reasons for a tracheostomy
A tracheotomy is usually done for one of three reasons:- to bypass an obstructed upper airway;
- to clean and remove secretions from the airway;
- to more easily, and usually more safely, deliver oxygen to the lungs.
Airway Problems That May Require a Tracheotomy
- Tumors, such as cystic hygroma
- Laryngectomy
- Infection, such as epiglottitis or croup
- Subglottic Stenosis
- Subglottic Web
- Tracheomalacia
- Vocal cord paralysis (VCP)
- Laryngeal injury or spasms
- Congenital abnormalities of the airway
- Large tongue or small jaw that blocks airway
- Treacher Collins and Pierre Robin Syndromes
- Severe neck or mouth injuries
- Airway burns from inhalation of corrosive material, smoke or steam
- Obstructive sleep apnea
- Foreign body obstruction
- Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
- Chronic pulmonary disease to reduce anatomic dead space
- Chest wall injury
- Diaphragm dysfunction
- Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm
- Aspiration related to muscle or sensory problems in the throat
- Fracture of cervical vertebrae with spinal cord injury
- Long-term unconsciousness or coma
- Disorders of respiratory control such as congenital central hypoventilation or central apnea
- Facial surgery and facial burns
- Anaphylaxis (severe allergic reaction)
How a tracheostomy is performed
Surgical Anatomy
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The innominate artery crosses from left to right anterior to the trachea at the superior thoracic inlet. Its pulsations can be palpated and occasionally seen in the suprasternal notch especially in case of a high riding vessel, representing a contraindication for a bedside percutaneous or open tracheostomy.
The isthmus of the thyroid gland lies across the 2nd to 4th tracheal rings and must be dealt with in any procedure at or around the upper trachea.
Indications for PDT
They are the same as a routine open operative tracheostomy with particular attention to contraindications.1Contraindications for PDT
Absolute:
Emergent tracheostomy ( i.e., securing emergent airway) in any patient population, infants and children (<15 years)
Relative Surgical Contraindications: Poor neck landmarks, neck mass (e.g. goiter), high innominate or pulsating vessels, previous neck surgery, limited neck extension, severe coagulation (uncorrected)
Relative Anesthetic Contraindications:
High PEEP (>18 cm), high airway pressure (>45 cm), high FiO2 (80%), retrognathic mandible with a limited view of the larynx on laryngoscopy
Preparation for Tracheostomy
Once the decision to perform a tracheostomy has been made, the surgeon must determine if the patient is a good candidate for the surgery and obtain written informed consent. In addition, the range of motion of the neck needs to be assessed. The tracheostomy team, including the surgeons and anesthesiologists need to discuss the entire sequence and alternatives to the procedure. All equipment must be available and functioning properly.Equipment
A regimented approach to preparation and performance of the procedure has been shown to significantly reduce the incidence of procedural complications4.Our approach includes the following equipment and protocols:
- We routinely use Cook Blue Rhino single dilator kit and videobronchoscopy to perform the procedure.
- The following must be available:
- An attending anesthesiologist must be present for maintenance of airway, provision of intravenous sedation and performance of bronchoscopy.
- An intubation roll and a cricoid hook.
- Open tracheostomy set.
Technique
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| Watch a tracheostomy (24 MB Windows Media file) |
Positioning
- The patient’s neck is extended over a shoulder roll (unless there is a contraindication).
- The anesthesiologist stands at the head end of the bed and under direct laryngoscopy positions the endotracheal tube (ETT) so that the cuff is midway at the vocal cord level.
- We routinely inject the skin with 1% lidocaine with 1:100,000 epinephrine solution.
- A horizontal or vertical incision centered on the inferior border of the cricoid cartilage may be used. We routinely use a 3-4 cm vertical incision.
- A minimal dissection is performed onto the pretracheal tissue in order to push the thyroid isthmus downward.
- The larynx is stabilized and pulled cephalad with the operator’s left hand.
- A bronchoscopy is then performed and the light reflex is used to select the best site for the introducer needle.
- Placing the needle at the inferior edge of the light reflex, the tip of the needle is directed caudad into the tracheal lumen avoiding the posterior tracheal wall at all cost.
Introduction of Guide Wire, Stylet and Initial Tract Dilatation The needle is withdrawn while keeping the cannula in the tracheal lumen. A J-tipped guide wire is then place under vision. The stylet is then placed with the safety ridge directed towards the tip of the wire. The tract is then dilated with the 8 FR dilator.
Dilatation with the Blue Rhino Dilator The Blue Rhino dilator is loaded on the stylet with the tip resting on the safety ridge. The dilator is moved in and out to optimally dilate the tissue between the skin and the tracheal lumen. The Blue Rhino dilator is never advanced beyond the point where 40 FR mark disappears below the skin level.
Placement of the Tracheostomy Tube
- A tracheostomy tube is loaded onto the dilator
- Females: a size 6 cuffed Shiley tracheostomy tube is loaded on to the 26 FR dilator
- Males: a size 8 cuffed Shiley tracheostomy tube is loaded on to the 28 FR dilator - The dilator is then loaded on the safety ridge of the stylet and placed into the tracheal lumen under direct visualization.
The bronchoscope is withdrawn from the ETT and introduced via the tracheostomy tube. The placement is confirmed by visualizing the carina.
Securing the Tube
We routinely secure the tube with 2 sutures of 2-0 nylon on each side of the flange. In addition, a tracheostomy tape is used to hold the tube in place. A flexible extension tube is used to connect the tube to the ventilator circuit to avoid undue movement of the tube in the immediate postoperative period.
Postoperative Consideration
A chest X-ray is not routinely required as long as the entire procedure was done under direct visualization and there were no adverse events intraoperatively6. The postoperative care is same as for the open procedure.The tract between the skin and the tracheal lumen takes a little longer (10-14 days) to mature as there is no formal layer by layer dissection involved. We, therefore, perform the first tube change on Day 10-12 postoperatively.
Bedside Percutaneous Dilational Tracheostomy (PDT)
Overview
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| Watch video of procedure |
Two critically important preoperative criteria for PDT are:
- The ability to hyperextend the neck
- Presence of at least 1 cm distance between cricoid cartilage and suprasternal notch ensuring that the patient will be able to be reintubated in case of accidental extubation
- Children (younger than 12 years of age)
- Obese
- Patients with severe coagulopathies
Techniques
There are several different systems and approaches for PDT. Following are brief descriptions:Ciaglia (method used at Hopkins)
With this technique, there is no sharp dissection involved beyond the skin incision. The patient is positioned and prepped in the same way as for the standard operative tracheostomy. General anesthesia is administered and all steps are done under bronchoscopic vision.
Procedure:Shachner (Rapitrac) systemAfter making a small skin incision, the surgeon passes a dilator tracheotome over the guidewire into the trachea to dilate the tract fully in one step. The tracheotome has a beveled metal core with a hole through its center that accommodates a guidewire. Once inside the trachea, the tracheotome is dilated. A conventional tracheostomy cannula, fitted with a special obturator, is passed through the tracheal opening. The dilator and obturator are then removed.
- Skin incision is made and the pretracheal tissue is cleared with blunt dissection.
- Endotracheal tube is withdrawn enough to place the cuff at the level of the glottis.
- Endoscopist places the tip of the bronchoscope such that the light from its tip shines through the surgical wound.
- Operator enters the tracheal lumen below the second tracheal ring with an introducer needle.
- The tract between the skin and the tracheal lumen is then serially dilated over a guidewire and stylet.
- A tracheostomy tube is placed under direct bronchoscopic vision over a dilator.
- Placement of the tube is confirmed again by visualizing the tracheobroncial tree through the tube.
- Tube is secured to the skin with sutures and the tracheostomy tape.
- We routinely use Ciaglia Blue Rhino Percutaneous Tracheostomy Introducer Tray.
Translaryngeal tracheostomy (Fantoni’s technique)
Unlike the other techniques, the initial puncture of the trachea is carried out with the needle directed cranially and the tracheal cannula inserted with a pull-through technique along the orotracheal route in a retrograde fashion. The cannula is then rotated downward using a plastic obturator. The main advantage of Fantoni’s tracheostomy is the minimal amount of skin incision required, with practically no bleeding observed. It should be noted that the procedure can only be carried out under endoscopic guidance, and rotating the tracheal cannula downward may pose a problem – demanding that the surgeon have more experience.
Advantages of PDT
Although there is a learning curve to the technique of PDT, it is relatively easy to learn. The learning curve may be overcome by performing a number of supervised procedures. Other advantages include:
- Time required for performing bedside PDT is considerably shorter than that for an open tracheostomy
- Elimination of scheduling difficulty associated with operating room and anesthesiology teams for critical care patients
- PDT expedites the performance of the procedure because critically ill patients who would require intensive monitoring to and from the operating room need not be transported
- Cost of performing PDT is roughly half that of performing open surgical tracheostomy due to the savings in operating room charges and anesthesia fees
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Complications and Risks of Tracheostomy
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Early Complications that may arise during the tracheostomy procedure or soon thereafter include:
- Bleeding
- Air trapped around the lungs (pneumothorax)
- Air trapped in the deeper layers of the chest(pneumomediastinum)
- Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)
- Damage to the swallowing tube (esophagus)
- Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)
- Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls. Blockages can be prevented by suctioning, humidifying the air, and selecting the appropriate tracheostomy tube.
Over time, other complications may arise from the surgery.
Later Complications that may occur while the tracheostomy tube is in place include:
- Accidental removal of the tracheostomy tube (accidental decannulation)
- Infection in the trachea and around the tracheostomy tube
- Windpipe itself may become damaged for a number of reasons, including pressure from the tube; bacteria that cause infections and form scar tissue; or friction from a tube that moves too much
Delayed Complications that may result after longer-term presence of a tracheostomy include:
- Thinning (erosion) of the trachea from the tube rubbing against it (tracheomalacia)
- Development of a small connection from the trachea (windpipe) to the esophagus (swallowing tube) which is called a tracheo-esophageal fistula
- Development of bumps (granulation tissue) that may need to be surgically removed before decannulation (removal of trach tube) can occur
- Narrowing or collapse of the airway above the site of the tracheostomy, possibly requiring an additional surgical procedure to repair it
- Once the tracheostomy tube is removed, the opening may not close on its own. Tubes remaining in place for 16 weeks or longer are more at risk for needing surgical closure
High-risk groups
The risks associated with tracheostomies are higher in the following groups of patients:- children, especially newborns and infants
- smokers
- alcohol abusers
- diabetics
- immunocompromised patients
- persons with chronic diseases or respiratory infections
- persons taking steroids or cortisone
Types of Tracheostomy Tubes
A tracheotomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe (Trachea)). There are different types of tracheostomy tubes that vary in certain features for different purposes. These are manufactured by different companies. However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator. The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted.
There are different types of tracheostomy tubes available and the patient should be given the tube that best suits his/her needs. The frequency of these tube changes will depend on the type of tube and may possibly alter during the winter or summer months. Practitioners should refer to specialist practitioners and/or the manufacturers for advice.
| Tube | Indication | Recommendations |
| CuffedTube with Disposable Inner Cannula | ||
 | Used to obtain a closed circuit for ventilation | Cuff should be inflated when using with ventilators.
Cuff should be inflated just enough to allow minimal airleak. Cuff should be deflated if patient uses a speaking valve. Cuff pressure should be checked twice a day. Inner cannula is disposable. |
| Cuffed Tube with Reusable Inner Cannula | ||
 | Used to obtain a closed circuit for ventilation | Cuff should be inflated when using with ventilators.
Cuff should be inflated just enough to allow minimal airleak. Cuff should be deflated if patient uses a speaking valve. Cuff pressure should be checked twice a day. Inner cannula is not disposable. You can reuse it after cleaning it thoroughly. |
| Cuffless Tube with Disposable Inner Cannula | ||
 | Used for patients with tracheal problems
Used for patients who are ready for decannulation | Save the decannulation plug if the patient is close to getting decannulated.
Patient may be able to eat and may be able to talk without a speaking valve. Inner cannula is disposable |
| Cuffed Tube with Reusable Inner Cannula | ||
 | Used for patients with tracheal problems
Used for patients who are ready for decannulation | Save the decannulation plug if the patient is close to getting decannulated.
Patient may be able to eat and may be able to speak without a speaking valve. Inner cannula is not disposable. You can reuse it after cleaning it thoroughly. |
| Fenestrated Cuffed Tracheostomy Tube | ||
 | Used for patients who are on the ventilator but are not able to tolerate a speaking valve to speak | There is a high risk for granuloma formation at the site of the fenestration (hole).
There is a higher risk for aspirating secretions. It may be difficult to ventilate the patient adequately. |
| Fenestrated Cuffless Tracheostomy Tube | ||
 | Used for patients who have difficulty using a speaking valve | There is a high risk for granuloma formation at the site of the fenestration (hole). |
| Metal Tracheostomy Tube | ||
 | Not used as frequently anymore. Many of the patients who received a tracheostomy years ago still choose to continue using the metal tracheostomy tubes. | Patients cannot get a MRI.
One needs to notify the security personnel at the airport prior to metal detection screening. |
Living with a Tracheostomy
Troubleshooting a tracheostomy changeTracheostomy care/suctioning
Stoma care
Tracheostomy equipment
Tracheostomy equipment cleaning and care
Eating with a tracheostomy
Speech with a tracheostomy
Tracheostomy as a Passey Muir Valve
Suctioning a tracheostomy
Traveling with a tracheostomy
Swimming with a tracheostomy
Tracheostomy Humidification
Decannulation
Professional Organizations
American Academy of Otolaryngology - Head and Neck Surgery
American Association for Respiratory Care
Resources for Nurses Caring for Patients with a Tracheostomy Society of Otorhinolaryngology and Head-Neck Nurses, Inc. (SOHN)
AAOHNS Conferences and Events
Support Group
Cardiac Nursing Tools and Books to Review.......
Publication Date: Jan 24, 2008
Availability: IN STOCK
Format: Chart
Edition: Second
ISBN/ISSN: 9780781773386
With updated images and text and improved design elements, this new edition chart provides an easy-to-understand overview of the important anatomical aspects of heart disease. The progression of heart disease in atherosclerosis is shown in three stages, each with an anatomical image of the surface or cross-section of the heart, a cross-section of an artery, and a cross-section of the heart wall. The stages show how a narrowed artery leads to ischemia; how a blocked artery leads to a myocardial infarction (heart attack); and show the recovery period with collateral blood supply.
The chart also shows heart disease in hypertension which can lead to hypertrophy and dilation of the left ventricle. Congestive heart failure, mitral valve prolapse, and the effects of aging on the heart are also illustrated and described.
For comparison, the chart also contains illustrations of normal heart anatomy, including anterior surface and cross-sections of the heart, the systems coronary arteries on the heart, and a cross-section of a normal coronary artery.
The chart also shows heart disease in hypertension which can lead to hypertrophy and dilation of the left ventricle. Congestive heart failure, mitral valve prolapse, and the effects of aging on the heart are also illustrated and described.
For comparison, the chart also contains illustrations of normal heart anatomy, including anterior surface and cross-sections of the heart, the systems coronary arteries on the heart, and a cross-section of a normal coronary artery.
Practical Guide to Cardiac Pacing
Publication Date: Jan 30, 2007
Availability: IN STOCK
Format: Book
Edition: Sixth
ISBN/ISSN: 9780781788816
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Anatomical Chart Company's Illustrated Pocket Anatomy: Anatomy of The Heart Study Guide
Publication Date: Sep 12, 2007
Availability: IN STOCK
Format: Folding Pocket Chart
Edition: Second
ISBN/ISSN: 9780781776813 - $10.00 u.s.d
Now in its Second Edition, this folding study guide takes the Anatomical Chart Company's most popular anatomical images and puts them in a durable, portable format that is perfect for the on-the-go student. Printed on a write-on, wipe-off laminated surface, this guide shows numbered anatomical structures and contains answers that can be concealed for easy self-testing and memorization. This edition features a fresh, clean design, updated content, and improved organizational features such as key subject headers at the top of each panel.
This quick reference includes:
This quick reference includes:
- Anterior (including cutaway view) and posterior views of heart
- Coronary arteries and veins, including cross-sections of artery and vein
- Thorax anatomy
- Circulation
- View and text explanation of the cardiac cycle including atrial systole, ventricular systole, and diastole
- Explanation of blood pressure and lists of normal, low, and high BP levels
- Illustrations and explanations of cardiac conduction, valves, and electrocardiogram (ECG)
Clinical Cardiac Electrophysiology
Techniques and Interpretations
Publication Date: Jun 17, 2008
Availability: IN STOCK
Format: Book
Edition: Fourth
ISBN/ISSN: 9780781777391
Nursing Textbooks to check out.........
Latest Edition click Image for more...... | ||||
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![[cover image of Brunner and Suddarth's Textbook of Medical-Surgical Nursing]](http://download.lww.com/wolterskluwer_vitalstream_com//thePoint/9780781785891_Smeltzer/QA12e/images/image-nclex_faq_book.jpg)
Nursing Procedure Book.....Evidence -Based Nursing
Best Practices: Evidence-Based Nursing Procedures
Publication Date: Jun 23, 2006
Availability: IN STOCK
Format: Book
Edition: Second
ISBN/ISSN: 9781582555324
Now in its Second Edition with a new title, Best Practices: Evidence-Based Nursing Procedures is an excellent compilation of "best" practices based on current research and expert consensus findings. This timely, authoritative reference applies research findings directly to every aspect of nursing practice to guide nurses in performing procedures for patients with a full range of conditions and illnesses.
This edition provides a thorough update and review and includes new procedures and practices. Every entry is evidence-based, identifies the sources of the evidence, and now includes manufacturer recommendations. Nursing diagnoses, expected outcomes, and unexpected outcomes (complications) are now discussed for each procedure.
New Nursing Drug Handbook for 2012....with over 3000 drugs....
The 32nd edition of the best-selling, original drug handbook for nurses has been revised, updated, and completely redesigned—with generic drugs alphabetically arranged for even faster access to drug and patient care information! This reliable guide offers comprehensive information on more than 1,000 generic and 3,000 brand-name drugs, with special attention given to maintaining patient safety: readers will find tall-man lettering, prominent black box warnings and clinical alerts, overdose signs and symptoms, look alike-sound alike drugs, easy-to-spot drug action and I.V. administration information, a new chapter on safe drug administration, and three brand-new appendices covering best practices for avoiding common drug errors, pediatric drugs commonly involved in drug errors, and elder care medication tips. All drug entry names are highlighted for easy retrieval of information, with therapeutic and pharmacologic classes clearly identified.
Nursing2012 Drug Handbook includes the ever-popular color photo-guide (enhanced with even more drugs), A-to-Z tabs to quickly locate drug entries, detailed coverage of selected drug classifications, 17 appendices, and FREE online access to monthly drug updates and news, FDA warnings, patient teaching sheets, and a robust Toolkit packed with an array of indispensable tools—including drug safety guidelines and videos, pharmacology animations, pronunciation guides and translators, pediatric and geriatric tips/guidelines, dosage calculator, I.V. compatibility chart, and more.
Recommended iPhone and iPod touch Nursing Apps for your viewing pleasure...........
Recommended iPhone and iPod touch Nursing Apps
Professional Nursing Knowledge and Judgment Required
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- Regardless of the publisher or developer, errors can exist.
- Nursing apps for iPhone or iPod touch will never be a substitute for professional nursing knowledge, experience, and judgment of the practicing nurse or student nurse.
- Verify that your facility or educational department approves an app before purchasing or using it.
- Cite references according to your department’s policies.
- The right and best app for you will depend on your unique requirements, specialty, and circumstances.
-
For software features that require Internet access, iPhone requires 3G or Wi-Fi, and iPod touch requires Wi-Fi.
The prices below are accurate at the time of the web page’s last update. Prices fluctuate constantly. Click the iTunes App Store Button for the app’s current price.
iPhone iPod touch Nursing Applications Suites Comparison
Nursing apps suites are expensive, and shopping and researching for the right suite to fit your needs can be frustrating and confusing.Read all the fine print at each developer’s website and iTunes App Store page because each developer has different terms and conditions and different purchasing instructions and options.
Unbound Medicine vs. Skyscape vs. Lexi-Comp vs. Epocrates
Skyscape’s Nursing Constellation Plus and Unbound Medicine’s Nursing Central are very similar. They both include:- Davis’s Drug Guide for Nurses
- Diseases and Disorders: A Nursing Therapeutics Manual
- Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications
- Taber’s Cyclopedic Medical Dictionary
The Winner: Unbound Medicine’s Nursing Central
Nursing Central $159.99
Why it wins by a substantial margin for nursing students and many nurses:
- The iPhone and iPod touch apps are permanently functional even after the 12-month subscription for updates ends.
- Most importantly included in the price is 12 months of access to the Nursing Central website. In fact, the Nursing Central website existed even before the iPhone and iPod touch native apps, and it is an excellent online resource.
- The user interface mirrors Apple and iPhone’s design philosophy of productivity through simplicity and ease-of-use. In real-world use, this is significant.
- Drug and term audio pronunciations (requires Internet access).
- Provide free-trial versions for both the native iPhone and iPod touch native apps and the Nursing Central website.
- Years ago, the Nursing Central website had a fully functional trial Open House. This is how we first discovered and tested Nursing Central.
- Visit DrugGuide.com and search for “acetaminophen” to try out Davis’s Drug Guide .
- Visit Unbound MEDLINE.
- Visit Taber’s Online for a completely crippled peek.
- The actual Nursing Central website user interface consolidates all these features and is easy to use and powerful. Again, they need to implement a free-trial version.
Individual Unbound Medicine iPhone and iPod touch Apps
If you prefer not to buy a nursing software suite, Go Student Nurse highly recommends Unbound Medicine’s Davis’s Drug Guide for Nurses and RNotes®.
Davis’s Drug Guide for Nurses $49.95
Excellent. Includes 12 months of access to DrugGuide.com.
RNotes® — Unbound $29.95
Excellent.
Tabers’s Medical Dictionary $49.95
Includes 12 months of access to Taber’s Online.
Davis’s Laboratory and Diagnostic Tests $49.99
Website access only available with Nursing Central suite.
Diagnosaurus DDx $0.99
Skyscape Nursing Apps — Confusing User Interface
Compared to Unbound Medicine and Lexi-Comp, Skyscape’s biggest downfall is its atrocious user interface for iPhone and iPod touch nursing software applications.If the user interface looks cluttered and confusing, imagine what it’s like to use, especially in a fast-paced environment.
Can you guess which one is Skyscape in the images below?
Hint: Do you immediately know what I, A, Pk, CP, AE, Ix, Do, Im, UB or x stands for? Neither do we.
Click the image below for a larger view.
the free Skyscape Medical Resources despite the horrible user interface. The free suite includes:
- Outlines in Clinical Medicine Nice content.
- RxDrugs Drug Guide Worthless for student nurses or nurses, especially compared to the excellent and free Epocrates Rx, which is discussed later in this web page.
- Archimedes Medical Calculator Many more tools than Epocrate’s MedMath, but that horrid user interface.
Here’s a hint: Numeric keys vs. QWERTY keys for a “cal-cue-lay-tor.” Also, compare the input field size.
Click the image below for a larger view.
- The nice thing about Skyscape is they offer many free-trial versions of their software.
- At their website and at the iTunes App Store, they have a large library of software applications that are not available elsewhere.
- On multiple occasions, we have found Skyscape’s customer service to be exceptional.
- Hopefully, they can address the user interface.
- If you decide to purchase Skyscape nursing apps for iPhone or iPod touch, Go Student Nurse recommends the Standard Version over the Subscription Version. Also consider the SkyPlatinum Membership for $24.95. Be sure to read all the fine print when ordering.
- According to Skyscape’s excellent 24/7 online chat customer service, their apps on iTunes are the Standard Version.
Skyscape Medical Resources Free
Skyscape Nursing Constellation Plus $179.99
Lexi-Comp Nursing Apps — Best Free Trial
- Nice user interface similar to Unbound Medicine.
- Possible deal-breaker: All apps are subscriptions only. No permanent apps are available.
- Best feature: Free 30-day trial of all apps in the horribly named Lexi-Comp Individual Application, so you can decide if any app fits your needs or specialty.
Lexi-Comp Individual Application Free
Lexi-SELECT $219.99
Lexi-PEDIATRIC SUITE $179.99
Epocrates Rx — Best Free Nursing Reference App
All nurses and nursing students should install Epocrates Rx on their iPhone or iPod touch. It’s a nice cross-reference to Unbound Medicine’s Davis’s Drug Guide.
Epocrates Rx Free
Informed Publishing Nursing & Medical Reference Guides
Beautiful user interface. Concise and relevant content. Awesome price.s the Informed Publishing apps using the iTunes links below.
(We do not recommend the Avatron Publishing PDF app versions that are also available in the iTunes App Store.)
Informed RN Pocket Guide $9.99
Excellent.
Informed Emergency & Critical Care Pocket Guide $9.99
Excellent.
More Nursing & Medical Reference Apps
Medscape Free
Excellent update.
Medical Encyclopedia Free
University of Maryland Medical System. Requires Internet access. Poor optimization: Slow.
Medical Abbreviations and Eponyms
Download the Joint Commission’s The Official “Do Not Use” List of Abbreviations, and read with any of the recommended iPhone or iPod touch PDF readers which are described later in this web page.
It’s handy to have multiple medical abbreviation apps.
Medical Abbreviations $0.99
Integrates one-touch access to Wikipedia Mobile and Google.
MedAbbreviations $0.99
Integrates one-touch access to Wikipedia Mobile and Google.
Quick Medical Terminology and Abbreviation Reference $0.99
Nice.
Medical Terminology Aid $3.99
Same as above plus custom flashcards.
Eponyms (for students) Free
Medical terms derived from a person’s name.
Eponyms $1.99
Foreign Languages and Medical Audio Pronunciations
Follow your department’s certified medical interpreter policies.
Pocket Medical Spanish with Audio $4.99
Excellent.
Pocket Medical French with Audio $4.99
Excellent.
MedSpeak Cantonese Translator Lite Free
MedSpeak Cantonese Translator $14.99
MedSpeak Mandarin Translator Lite Free
MedSpeak Mandarin Translator $14.99
Drug Pronunciations Lite Free
Drug Pronunciations 2.99
Microbiology Pronunciations Lite Free
Microbiology Pronunciations 2.99
Maternal, Labor and Delivery, and OB Nursing App
Perfect OB Wheel $1.99
Easy to use. Worked great in my L&D rotation.
iPhone and iPod touch Games for Pediatric Nursing
These games really helped me with my pediatric clinical, but think carefully if you want to risk damaging or losing your expensive iPhone or iPod touch.
Talking Carl $0.99
One of my favorite apps. I learned about it from designer Alex Malkin’s funny video and tweet.
Pocket God $0.99
Kid pleaser at all ages.
Flight Control $0.99
Child and adult favorite.
Wallace & Gromit Free
Comic book.
Miscellaneous Nursing Apps
Blackbag Free
Medical News
GCS Free
Glasgow Coma Scale
STAT Adult Immunization Free
CDC immunization schedules for adults only.
STAT Immunization $4.99
CDC immunization schedules for children and adults.
You can also download CDC immunization schedules and read them with any of the recommended iPhone or iPod touch PDF readers which are described later in this web page.
Location Based Information Apps — Requires Internet
For restaurants, gas stations, supermarkets, hotels, etc. Many include reviews and directions. Nice for community nursing, travel nursing, and personal use.
AroundMe Free
MapQuest 4 Mobile Free
Urbanspoon Free
Fun.
Yelp Free
YPmobile Free
Yellow pages.
Personal Productivity Apps for Nurses and Nursing Students
BeejiveIM with Push $9.99
Integrated interface for multi-service instant messaging. Awesome.
Skype Free
Free Internet phone calls and instant messaging.
Units Free
Easy-to-use and free unit conversion app.
WeatherBug Free
Weatherbug Elite $0.99
Awesome weather app. Love it. No ads. More features.
Dictionary.com Free
My Lists $1.99
Simple, easy & cheap.
To Do Free
Simplest.
Things $9.99
Popular, feature-rich task management app.
Delivery Status touch, a package tracker $4.99
Great for online shoppers.
Notetaking Apps and PDF/Document/File Readers
This is one of the most important categories for me as a student, a reader, and a writer.With many of the apps below, iPhone and iPod touch can store, read, and/or email MS Office, iWork ’09, PDF, HTML, RTF, RTFD, TXT, and image files. Be sure to read the specific app’s iTunes page for supported features.
PDF files are nice as they retain all formatting. If you use a Mac, PDF support is built into OS X by “printing” to create a PDF file. With OS X’s Preview app, you can manipulate PDF files. Although it’s expensive, Adobe Acrobat Professional is great for the power user.
I’m 95% paperless, and all my notes, lecture PowerPoints, and PDFs reside on my iPhone or iPod touch where I can review them while I’m standing in line, at the beach (tip: touchscreen works even through Ziploc bags), or just about anywhere.
My workflow revolves around Notebooks and Good Reader. These two apps can handle just about anything. The other apps have also been tested and work well. They are listed to give you more choices to meet your individual preferences or workflow needs.
Notebooks — Write Notes and Store Files $5.99
One of my favorite iPhone and iPod touch apps. It’s powerful and customizable. Go Student Nurse would not exist without this app. It has increased my productivity significantly. I use it for journaling, personal notes, and drafting all sorts of written content.
It stores, reads, and emails most types of files and has a robust file and folder management interface.
Alfons Schmid is the developer of Notebooks and his customer support is outstanding. I requested an option for adjustable colors for background and font colors for text files, and he delivered it in a subsequent update.
Good Reader (Large PDF Viewer) $0.99
Worth every dime. Amazingly powerful, stable, and fast. This app will handle nearly any PDF. Full of features: zoom, text search, bookmarks, orientation lock, scroll lock, passwords, and more. Although it can read many file types, it is the best app for PDF files, especially complex and large ones. Their customer support is also excellent.
Simplenote Free
Instant cloud sync and web browser access.
FileMagnet (Read, Email Documents) $4.99
My workhorse before I discovered Notebooks and Good Reader.
Air Sharing (View and Store Files) $2.99
Similar to FileMagnet.
Air Sharing Pro (Disk, Print, Email) $9.99
Same as Air Sharing with many more features.
Social Media Apps for Nurse and Nursing Student
Facebook Free
MySpace Mobile
Tumblr
I love Tumblr. Read Tumblr for Nurses and Nursing Students.
Tumblr Free
tumblr gear Free
Twitter for Nurses and Nursing Students
Twitter. It’s all about streams of consciousness and connectivity. It’s addictive and fun, especially with iPhone and iPod touch apps. Learn more about Twitter. Many apps below have Instapaper and TwitPic integration and allow easy management of multiple Twitter accounts.The right Twitter app has much to do with personal preference.
SimplyTweet $4.99
Beautiful and simple. Twilight (black) theme. 2-5 minute push notifications. Multiple accounts.
Twitter Free
Excellent. Dealbreaker: No traditional retweet function.
Boxcar — Push Notifications
2 minute push notifications. Supports multiple accounts. Add services with a small one-time fee.
Twitterific Free
Nice.
Twitterific Premium $4.99
Same as free version, but without advertisements.
Twittelator Free
Feature-filled.
Twittelator Pro $4.99
Includes all features.
Echofon for Twitter Free
Good.
Echofon Pro for Twitter $4.99
Multiple accounts. More features.
Apps for Nurses and Nursing Students That Love to Read
Instapaper Pro is one of my favorite iPhone and iPod touch apps. It’s very easy to use, but a bit hard to describe. Read the Instapaper FAQ, and try out the free app below. Many RSS feeds are now on Twitter and work great with Go Student Nurse recommended iPhone and iPod touch apps for Twitter since they all have Instapaper integration.
Instapaper Free
Instapaper Pro $4.99
I love this app. Many extra features over free version.
There are many ebook apps available. What I use:
Kindle for iPhone Free
Classics $2.99
B&N Bookstore Free
Check inventory and reserve books at local stores.
Utility Apps
Best Camera $2.99
I love this app and philosophy: The Best Camera by Chase Jarvis website.
1Password Pro $14.99
A power user must-have, especially for Mac owners.
Speedtest.net Speed Test Free
Test your Wi-Fi, 3G, or EDGE speed.
MobileMe iDisk Free
For MobileMe subscribers.
Keynote Remote $0.99
For Keynote in Apple’s iWork ’09.
Remote Free
For iTunes and Apple TV.
Internet Radio Apps
Many iPhone and iPod touch radio apps are available. You can output the sound to your car or home stereo if you have an auxiliary input and the correct cable.For the best dance music, check out Energy 98. My favorite Internet radio station since 2003. They also have a weekly new dance music show called The Listening Room that is also available as a free weekly podcast.
SHOUTcast Radio Free
Thousands of free Internet radio streams.
TuneIn Radio $1.99
TiVo-like: listen/record/replay. Option to listen in background in Safari on iPhone.
Pandora Radio Free
Nursing Apps Not Rated by Go Student Nurse
Handbook of Nursing Diagnosis $39.99
Unbound Medicine
Merck Manuals $49.95 – 79.95
Unbound Medicine
Pocket Guide to Diagnostic Tests $39.99
Unbound Medicine
Cram Fighter: NCLEX-RN Edition $4.99
Customized NCLEX study scheduler.
American Heritage Desk $3.99
American Heritage Deluxe $34.99
Lipid Calc $0.99
CHADS2 Score Free
MedRef $0.99
Normal Lab Values $1.99
MedCalc Free
Acid Plus – The ABG Calculator $3.99
iMurmur 2 $2.99
Code Blue $.99
Search iTunes for More Nursing iPhone and iPod touch Apps
Click the iTunes button above and type the terms below in the iTunes search field for many more iPhone and iPod touch nursing apps, nursing applications, and nursing software for nurses, student nurses, and nursing school:
- anatomy
- ECG, EKG
- infuse, infusion
- IV
- Wikipedia
- dictionary
- USPS, UPS, FedEx
- UK iTunes: Nursing Jobs (free app)
Medical & Nursing iPhone and iPod touch Profile
Medical & Nursing iPhone and iPod touch Profile
Medical & Nursing iPhone and iPod touch Profile
Medical & Nursing iPhone and iPod touch Profile
AirStrip Technologies supports iPhone to securely deliver critical patient information, including virtual real-time waveform data.Although nursing students and nurses might not use AirStrip applications, AirStrip is highlighted to show the momentum of iPhone in all healthcare professions.
Speaking with The Unofficial Apple Weblog (TUAW), AirStrip’s President and Chief Medical Officer, William Cameron Powell, MD, states that iPhone is “a paradigm shift” and “game changing.”
Future Medical Accessories Development
With the iPhone Accessory API (application programming interface), developers can engineer integrated medical software and hardware solutions:- blood glucose monitoring
- blood pressure monitoring
- EKG monitoring
- spirometric monitoring
- bar code readers for medication and patient ID numbers
What are the differences between iPhone and iPod touch?
Apple’s iPhone and iPod touch web pages and videos detail usage, features, and specifications. You can also visit your local Apple Retail Store.
Both devices are compatible with Windows and Apple Mac computers and will run nursing software sold exclusively through the App Store using iTunes.
How do I buy iPhone 4 and transfer my phone number?
For a qualified AT&T customer in the U.S., iPhone 4 starts at $199 with a 2-year contract. All iPhone cellular plans include mobile 3G Internet access.
Presently, AT&T is the exclusive iPhone wireless provider. AT&T’s CEO stated this would not last forever.
Visit AT&T Wireless to learn about their mobile phone and data plans for iPhone.
Verify voice and data coverage for your local area using the AT&T Coverage Viewer.
If you are with a non-ATT carrier and would like to switch, verify with your carrier for any applicable early contract termination fees.
Transferring (or porting) your current number is easy if you are eligible. AT&T’s Local Number Portability FAQ clearly explains the process.
You can buy iPhone from Apple, AT&T, Best Buy, Radio Shack, and Walmart.
iPhone is also available internationally with various wireless carriers.
Why iPhone instead of iPod touch for nurses, nursing students, and nursing school?
iPhone: Less Stuff in Your Purse or Pocket
Everything is integrated and mobile: phone, iPod, email, Internet, camera, video, and apps.iPhone: Mobile 3G Internet for Everything
You can instantly find a picture of the appendix to teach your 10-year-old patient about appendicitis.
Search & Teach
But, your life as a nurse or nursing student is not just about nursing. Are you in an unfamiliar neighborhood and don’t know where to eat? Use the Urban Spoon, Yelp, or Maps app to find a pizzeria, get contact info, and directions.
Suppose you’re at Apple’s campus in Cupertino, California:
- Type pizza in iPhone’s Maps app.
- The red pins indicate nearby pizzerias.
- You decide on Pizza My Heart and get address info and directions.
- Tap on the orange and white “little guy or gal” symbol to the left of Pizza My Heart, and you’ll see a Google Street View.
How do I type on iPhone or iPod touch?
What type of iPhone or iPod touch nursing apps or applications are available?
Based on real-world testing and interviews from practicing nurses and nursing students, Go Student Nurse has published numerous reviews and recommendations for iPod touch and iPhone nursing applications at the following web page:
Recommended Nursing Apps — iPhone iPod
Apps can be purchased individually or sold in bundled suites, and prices range from free to over $200. Apps include drug guides and numerous medical references (terminology, labs, pathophysiology, nursing skills, etc.).
For a practicing nurse or a student nurse, personal productivity apps are also important. Many apps are included with iPhone or iPod touch such as Mail, Calendar, Contacts, and Maps.
Other productivity apps include ebook and document readers (Office, iWork, PDF, Kindle, etc.), English and foreign language dictionaries, and unit conversion calculators.
For mindbody health, there are thousands of apps to increase the enjoyment of your personal life outside of work and school: games, restaurants, cinemas, hotels, music, radio, ebooks, videos, travel, exercise, personal health, photography, etc.
Price does not dictate quality. Thousands of apps are free, and thousands more are $1–5.
Epocrates Rx
A great free app is Epocrates Rx, and it should be on every nurse’s iPhone or iPod touch. It includes an excellent drug guide, InteractionCheck, and Pill ID images. It also includes the MedMath calculator and reference which would be an amazing app on its own.Click the images below for a larger view.
What is push email?
iPhone and iPod touch instantly notifies you when you have email.
A big productivity booster.
From Apple’s Supported Push Mail Accounts on iPhone and iPod touch:
Email accounts that use the push method for message retrieval enable you to have email messages delivered directly to you as soon as the message is received by your email provider instead of checking periodically or manually for new messages. On iPhone or iPod touch, push email is supported for the following email account types:Email accounts such as POP, IMAP, or AOL accounts do not support push message retrieval on iPhone or iPod touch but can instead be setup to fetch mail at specified intervals or manually when the Mail application is opened.
- MobileMe
- Microsoft Exchange
- Yahoo!
Note: A Wi-Fi connection is required to send and receive email on iPod touch.
What about Gmail?
Push Gmail via Google Sync
Should I purchase MobileMe?
The MobileMe website explains the features well.
- Duplicate contact and calendar data.
- Push email notification doesn’t always work.
- iDisk can be slow using Mac’s Finder. It’s fast using the MobileMe iDisk web interface.
- Sync problems with some Wi-Fi networks.
- Effortless sync for Mac, iPhone, iPod touch, and iPad devices.
- Steady, incremental improvements in reliability and features.
- Most of the time, the features work well, but you may have to waste time with MobileMe Chat support, support documents, and support forums for fixes and workarounds.
- Back to My Mac.
- Neat features: Find My iPhone, Remote Wipe, and iDisk for iPhone app.
- Excellent MobileMe Chat support.
How do I clean and protect iPhone or iPod touch?
Clean
Go Student Nurse recommends iKlear The Complete Cleaning Kit for Mac, iPhone, iPod touch, and iPad for nurses, nursing students, and nursing school.Read the directions, and keep fluids away from all openings to avoid damage.
The glass on iPhone 3GS, iPhone 4, and iPad has an oleophobic coating which makes cleaning easy with any soft cloth.
Protect
There are many cases available to suit your preferences.The glass on iPhone 3GS and iPad is extremely durable and scratch resistant, but not impact or drop resistant.
The iPhone 4 glass:
… the same type of glass used in the windshields of helicopters and high-speed trains.The video below shows the durability and scratch resistance of the glass on iPhone 3GS and iPad (the first 30 seconds is a parody of Apple videos):
The Apple Online Store and Apple Retail Stores no longer sell protective screen films for Mac, iPhone, iPod touch, or iPad.
The majority of us at Go Student Nurse no longer use protective screen films.
However, if your preference is to use a protective screen film, recommends Power Support Crystal Film (not the Anti-Glare Film). Reading the instructions, using Scotch Magic Tape, and having patience guarantees a dust- and bubble-free installation.
How long does the battery last?
It depends how you use it. Apple has dedicated web pages for iPhone and iPod batteries.
For a typical nurse or nursing student, the battery will easily last an entire 12 hour shift for workflows involving accessing the Internet, searching nursing references, and personal communications (email, voice, or text).
Because iPhone and iPod touch are so capable and powerful, owners tend to use their devices heavily which can quickly deplete the battery. Activities that deplete the battery the fastest are games, continuous Internet streaming such as Internet radio, and video recording and playback.
There are numerous third-party car chargers and external batteries to meet your mobile power requirements.
If you need a car charger, recommends the Belkin Micro Auto Charger with Charge Sync Cable which is sold at Best Buy and the Apple Online Store.
This item is especially useful for a community nurse, road-going nursing educator, or power user.
What is the resale value?
The full price of iPhone is often subsidized by wireless carriers with multi-year contracts.
Due to high demand, iPhone has very high resale value.
What about social and professional etiquette?
It’s like any other mobile phone or iPod. Use common sense and common courtesy.
Turn off the ringer and keyboard clicks (Settings > Sounds).
Some educators and hospital staff may view this type of technology with hostility.
Expect this. Plan, and act as the situation dictates.
Be flexible. Be diplomatic.
What are some ethical or social justice issues with this type of technology?
Is this technology really necessary for effective and improved educational and healthcare outcomes?
If a school or health facility requires a specific device, who should pay for it?
Do these devices give individuals who have the money and knowledge to use them an unfair advantage at school and at work?
Does society have an obligation to provide equal access to education and healthcare to its citizens?
Does this type of technology contribute to escalating educational and healthcare costs?
Personal and political values and beliefs on these issues don’t just affect an individual and family’s pocketbook, but they also shape the evolution of our human societies.
Why is Go Student Nurse so excited about iPhone, iPod, iPad, and iOS 4?
For me personally, it’s a revolution in personal and professional digital communication, information, and entertainment that has unleashed and expanded my own productivity and creativity which have enabled and fueled the creation of Go Student Nurse to be a worldwide advocate for nursing students and for the adoption of personal technology in nursing.
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