Transcription:
Specialized Nursing Care in Rural Area

Prakash Chandran: Many patients may not be aware of some of the specialized nursing care that is available in rural Northwest Kansas. The outpatient nursing team at Norton County Hospital can provide many services, and two of those nurses are joining me today to explain more about what they do in Norton. Let's welcome Travis Nykamp and Jay Alexander to the podcast who are both registered nurses for Norton County Hospital.

From the planes of rural Northwest Kansas to you, this is Health in the Heartland, presented by Norton County Hospital, where medical experts aim to empower health at any stage of life. My name is Prakash Chandran. So Jay and Travis, really great to have you both here today. I really appreciate your time. Travis, I wanted to maybe start by asking you what are some of the most common things that you see at Norton County Hospital?

Travis Nykamp RN: Well, we do a wide variety of services in the outpatient setting here at Norton County Hospital. And we do everything from wound care to IV antibiotics, specialty med infusions, and injections. Basically, pretty well any nursing service that can be performed in an outpatient setting, we can do here at Norton County Hospital. We do not perform chemo because Norton County Hospital does not have the proper ventilation hood for mixing chemo medications. But if, you know, see a medication on TV that is advertised, we can give it here at Norton County Hospital.

We've heard so many times with the services that we provide where people will say, "Oh, I had no idea you gave that infusion at Norton County Hospital. We assumed it was too small the facility to give that." In fact, we just had the other day someone told us that they had been traveling over two hours away to receive an infusion. And it was something that we give here at Norton County Hospital on a regular basis. And we can really, you know, save people a lot of trouble with travel time with something that we can do here very professionally and just as well as as can be given at a larger facility.

Prakash Chandran: Yeah, that convenience sounds amazing. And you mentioned something there around like IV antibiotics and some of the infusions. And Jay, that kind of leads me to the question about PICC lines. Can you broadly talk about what those are and what type of treatments can be administered through them?

Jay Alexander BSN, RN: Yeah. I have actually been a PICC line nurse for getting close to 20 years now. I am specialized in all age groups clear down to pre-term babies on that. But a PICC line is a long IV that you can place in your upper arms and it goes almost all the way to your heart and you can receive pretty much any medication through those safely without causing any damage to your veins. And, you know, you only get one poke. So you could be in the hospital a month and you only receive technically the one poke to put in the PICC line. They can draw all your lab samples off of those lines. It's just a wonderful thing to have for patient satisfaction. And if you have a fear of needles and things like that, it just makes it much more of an enjoyable stay. Needle sticks are the number one fear for people going into the hospital. They are very safe lines. They're pretty much a hundred percent antimicrobial, so very low risk of getting a infection from the line. And then, there's also a very small risk of getting a blood clot from them because it is a foreign object in your body but, again, incredibly small risks on those compared to being poked so many times with peripheral IVs and lab sticks.

Pretty much, Travis can also do all adults. And on top of that, we're also IV specialists just in general. We use ultrasound to access people's veins for lab work and IVs, pretty much almost a hundred percent success rate on that. So if you're a very, very difficult stick, it won't matter to us. We can still get you very easily using the ultrasound.

Prakash Chandran: So Travis, Jay started to touch upon this and you also talked about this as well, but you were talking about the administering of specialty drugs through those PICC lines. Can you speak at a high level about what type of drugs and conditions are treated through the PICC lines?

Travis Nykamp RN: So the PICC lines are used primarily for long-term antibiotic infusions, what we most commonly use them for which isn't necessarily a specialty medication. A common diagnosis is the diagnosis of osteomyelitis, which is an infection where the infection makes it down to the bone. And a lot of times with those infections, the patient will be receiving antibiotics for six weeks or so. And that's where a peripheral IV that's in the lower arm won't hold up to those infusions over that length of time, whereas a PICC line will last for the full six weeks and they'll only have to be poked once and then they don't have to be poked again.

The specialty infusions that we do are quite often anywhere from a medication that's received once a week to possibly even six months apart or even, I guess, there are ones that are only once a year. And those are just for kind of diagnosis such as Crohn's disease. There's one medication we give called Inflectra or Remicade is another brand name for it. And a lot of these medications, they treat these diseases such as Crohn's disease or psoriasis, some immunodeficiency, immunoglobulin deficiency kind of unusual conditions that you don't hear about super often. A lot of them are actual monoclonal antibodies where we're actually administering a type of antibody that binds to a certain antigen, and I don't want to get overly technical, but it binds to a specific antigen that's causing a problem in the patient's body. And so they're more, I guess, involved than just getting an antibiotic where there's more risk for reactions possibly. And so that's why we monitor these patients very closely during the infusions and keep an eye on them very closely and just allows us to be very involved with our patient's care that way too.

And one thing that I think is beneficial being in a small community is that we really get to know our patients well. We know, you know, their preferences their routines, everything, because, you know, a lot of these people we even know from the community as well. And so it really allows that personalized care that you may not get elsewhere as well.

Prakash Chandran: So Jay, one of the things that I've heard is that another form of a central line is Infusaports. Can you speak at a high level about this and how it relates to what you do at Norton County?

Jay Alexander BSN, RN: Yeah. An Infusaport is an implanted device that goes right underneath your skin on your chest usually. And basically, first glance, you would not know that the port is even there. But we take a needle and we actually access that port from the outside of the skin and they can receive all their medications safely, again, just like a PICC line, only you're going through the chest. And then, when you're done, you take the needle out and it's like they have no line. So they're much more convenient for very long term patients that may just have terrible veins or they're experiencing, you know, getting chemotherapy and those types of infusions.

So, I worked at Salina Regional as a resource specialist in all central lines there for 13 years. So basically, there's no one we can't get or nothing I haven't seen when it comes to Infusaports or central lines. Some of them are very difficult to access and some of them are very easy. But we definitely do very sterile technique with that and follow a very special routine of insertion and taking them out. Most people are on an every four-week flushing regimen some are six-week. It just depends on what the doctor likes. But we do a lot of those here in the area so that they don't actually have to travel to get those, a very quick procedure done, and we can just do it right here for them.

Travis Nykamp RN: And one thing I would like to add with those or reiterate with those central lines, those ports, is that due to Jay's expertise in that area and with his amount of time and he of course trained me, mentored me, and I've been working with him for probably getting close to two years now. And with that, I think a lot of people have the mentality that, "If I go to a larger facility, I'm going to get better care." And just a couple weeks ago, we had a patient in with a port and he made it very clear, he's like, "I would rather have you guys access my port than anybody. I've been to a lot of places, gotten poked a lot of places, and you guys are by far the best." I don't want to come across as arrogant or anything, but I just want to kind of push back against the common mentality that if you go to a larger city, you're going to get better care and that's not necessarily always the case. Not to talk badly about those larger facilities, but we can provide very high quality professional care here at Norton County.

Prakash Chandran: Yeah, that's very reassuring to hear just about, not only that, but just all the different services that people might not necessarily know about. Travis, I've also heard that you perform wound care at Norton County including wound VACs. Can you talk at a high level about what this is?

Travis Nykamp RN: Sure. So we provide a wide range of wound care here at Norton County Hospital. And that's something, once again, that a lot of patients assume they have to go to one of the larger surrounding facilities in order to actually go to a wound center. But basically, if there's a chronic wound, you know, that people have been dealing with, we would love to see them here at Norton County Hospital pretty much no matter what it is. We've had in the last six months multiple patients that have been dealing with wounds for multiple years and that we are able to get healed up which is always really exciting. So that's kind of at these basic level wounds, a lot of diabetics have chronic wounds that they fight with. And, you know, we are more than happy to help those people and help with their wound care issues.

And if we do have a wound that we feel like we aren't making progress with and need to have maybe some sort of surgical intervention, we have, you know, a general surgeon that comes to Norton County Hospital that we've had wonderful success with and having him help us with maybe doing some debriding, which is removing of bad tissue basically, and getting back to good tissue where we can get it healed up. And we also have a a podiatrist specialist that can help us with foot wounds if we have any questions or concerns. So, we have some wonderful resources that we can work with.

And then, with the wound VACs that you brought up, that is a device that provides continuous negative pressure or suction at the wound bed. And what that does is it keeps the wound very, very clean, as we can isolate that and completely protect it from the outside elements with that wound VAC being attached. And when it provides that continuous suction, it increases blood flow to the area and actually does continuous debridement, which once again is the getting rid of bad tissue and allows us to build up more rapidly a healthy wound bed and allow us to heal wounds a lot quicker than if we didn't have that wound VAC in place.

Jay Alexander BSN, RN: Yeah. And I will add that we do use KCI, which is a company out of Kansas city For our wound vacs. And they do ship them overnight. So we can actually start those quite rapidly on most people to get that therapy going right away, even post-surgery or anything like that. And then, another thing is just our local providers that we have right here, they work very well with us on finding the absolute best care in not just wound care, but all aspects of our care that we give here as an outpatient, really excellent teamwork among all of us to get the best outcomes.

Prakash Chandran: Now Jay, one of the final things that I wanted to discuss that you offer there at Norton County is therapeutic phlebotomies. Is that something that you can speak to?

Jay Alexander BSN, RN: Yeah, that's again something else I did in Salina there for a long time. It's just a way some people just produce too much blood and they need a unit of blood actually removed from them. Sometimes it's weekly, sometimes monthly, sometimes every six months, they just need a unit taken off. So it is quite a large needle when you do that, but again, we use ultrasound and can make it Incredibly easy for those patients.

So, one advantage of using that ultrasound for those is we can actually see inside the person's arm to see the biggest point and the best spot for a vein. So there's no guesswork going on. So we can place that IV just in the right spot to make sure those transfusions go very well and not have infiltrations and things like that. So most of those people are incredibly happy to be able to get a unit of blood off so quickly and have a good result and not get poked a bunch of times for that. But it all depends on how often the doctor orders them and lab work to see how effective they are.

Travis Nykamp RN: And one thing I might add with that is therapeutic phlebotomy is just one example of a specialized procedure that we can do. Another example would be Pleur-Evac drainage, which is a drainage of the pleural space, that being the space surrounding the lungs. Some people, their body wants to fill that space with fluid and they end up placing a line that allows us to drain that space.

I just remember talking to a client who went to a larger facility for something else. And when they came in with that Pleur-Evac, they said, "Oh, we need to bring in someone special because only a few people do those here. And they were absolutely floored when client said, "Oh, well, at Norton, they do it all and it's no big deal for them." And they were absolutely amazed by that, that we were able to do that procedure and do it so effectively and competently here at Norton.

So, you know, what I would just say to all the listeners out there is if there's some sort of procedure that you have to travel for we that needs to be done and doesn't require a physician to do it, obviously we can't do, you know, surgery or anything like that, but we are more than happy to, if nothing else, get a phone call and just talk to them and see if it's some sort of a service that we can provide for them here at Norton.

Prakash Chandran: So Jay, just before we close, is there anything else you'd like to share with our audience?

Jay Alexander BSN, RN: Yeah, I will like to mention that in the few years past here, we've always kind of struggled with finding enough space to do all of our outpatients. And with the new providers coming in, our patient flow has greatly increased and COVID also made that more of a struggle. So we have made the decision as a facility that we are going to be taking over the physical therapy space to make that into a new wound care and infusion center. PT will be moving down to actually the old medical clinic down the street. So we were actually going to have a nice excellent-sized wound care center and infusion center now. So we're really excited about having that extra space to handle more patients with more convenience.

Travis Nykamp RN: Yeah, the space down there is a lot larger than where we're currently at and it'll allow us to work a lot more efficiently and keep a closer tab on all of our patients all at the same time. It's a lot nicer of a space, a lot of windows. And so we're really excited about working down there and being able to provide even a higher level of care to our clients.

Prakash Chandran: Well, Jay and Travis, I think that is the perfect place to end. Thank you so much for your time today.

Jay Alexander BSN, RN: Thank you.

Travis Nykamp RN: Thank you.

Prakash Chandran: That was Travis Nykamp and Jay Alexander, two registered nurses for Norton County Hospital. Thanks for listening to Health in the Heartland, you can find out more about Norton County Hospital online at ntcohosp.com. Thanks for listening. My name is Prakash Chandran. Be well.