The Pulse November 2023 Issue

THE PULSE THE OFFICIAL MONTHLY DIGITAL PUBLICATION

Great Day Hikes close to Melbourne

Get to know Hao

Alternative Ice Cream Places

NOVEMBER 2023

Awesome & Amazing

VOLUME 3 ISSUE 6

CONTENTS 03

05

07

AROUND VICTORIA

SIGS IN FOCUS

ECMO CORNER

Great Day Hikes Melbourne Events

End of Life Care & Well-Being SIG Aggression Prevention SIG

What is DPC? Monitoring of DPC

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11

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ICU STAFF PROFILE

PATIENT SUCCESS STORIES

STAFF PHOTOS

Hello Hao

Ravinder Kashif

Post-Graduate 2023 Strike Bowling

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21

25

GASTRONOMY

AWESOME & AMAZING

EDITORIAL TEAM

Green Pasta Recipe Alternative Ice Cream Places

October nominations Nominate now

WELCOME The Team Leader (TL) Programme 2023 participants would like to present the November issue of The Pulse.

Welcome! We are glad to see you here.

As the summer season comes beaming in, we hope that your days are equally warm and bright.

Firstly to get you up and about, we have identified some great hiking trails and places to go around our marvellous state. To cool you down we have listed a gelato place that is quirky and piquant.

Secondly, we highlight our SIGs. We applaud and acknowledge all the positive contribution each one has made.

We also welcome all the new ICU staff that have commenced. We are energised by your presence. Featured here are some ICU information that may be useful in our shifts.

Lastly we say hello to Hao, our current expert clinical data analyst. Get to know him a bit more inside.

Enjoy!

Peter Andrew THE PULSE

Grazing the cover are our Night Shift Heroes: Elise, Caitlin, Kirsty, James, Zami, Christian and Eric

THE OFFICIAL MONTHLY DIGITAL PUBLICATION

THE EXPLORER

Great Day Hikes close to Melbs JAN JUC - BELLS BEACH COASTAL WALK Explore this stunning 9.7-km out-and-back trail near Torquay, Victoria. Return 2.5 hours, mostly flat. Finish with a dip in the ocean, and an ice-cream in Torquay before heading home.

Commute: 1.5 hours (ish) Melbourne - Jan Juc SUGARLOAF PEAK AND SOUTH JAWBONE PEAK LOOP Moderately challenging 11.3-km loop-de-loop trail in the Cathedral Ranges. The trail is open year-round and is beautiful to visit anytime. You'll need to leave pups at home — dogs aren't allowed on this trail! Allow 3 - 4 hours.

BUSHRANGERS BAY - CAPE SCHANK

Commute: 1.5-2 hours Melbourne - Cathedral Ranges

Down along the Mornington Peninsular, take this family friendly 6.9km hike along the coast. Bring your bathers and go for a swim in Bushrangers Bay should take 1.5-2 hours. Once you have finished, head to Flinders for a bite to eat or a glass of wine at the local wine bar!

Commute: 1 hour 20 mins Melbourne - Bushrangers Bay

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Written by Esther

MELBOURNE EVENTS BBC EARTH EXPERIENCE

BBC Earth Experience 27 October 2023 - 28 January 2024 Melbourne Convention and Exhibition Centre South Wharf

MARSHMALLOW LASER FEAST

Marshmallow Laser Feast: Works of Nature 23rd of November 2023 - 14th of April 2024 Australian Centre for the Moving Image Melbourne

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From The Concrete Playground Compiled by Peter

SIGs Spotlight END OF LIFE Created in Feb 2021 by a multidisciplinary team, the SIG brought together staff with a keen interest in end of life care (EOLC).

They have improved the unit’s practice in EOLC and have developed resources.

There is now a dedicated EOLC resource box at the flight deck.

The SIG also continues to support a positive organ and tissue donation culture and educate and support colleagues.

Yvette and Nellie are phenomenal leads. They are keen to support a CNS interested in gaining experience in stepping up in this role.

WELL-BEING Created in May 2022 as a spin off from the EoLC SIG, the purpose of the group is to invite discussion for new ideas around staff wellbeing, assist with retention, growth and highlight supports available for staff. It continued the monthly unit reflections (commenced by the EoLC SIG), highlights the Awesome and Amazing work of team members those that go above and beyond and assists with organising unit social activities.

The SIG have assisted in creating ‘The Pulse’ newsletter whenever the team leader program is not running. While meetings are organised by astonishing Nellie – it is very much a collaborative process with contribution from anyone welcome.

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Many Thanks to Nellie Presented by Grace W

SIGs Spotlight AGGRESSION PREVENTION AND MANAGEMENT SIG The Aggression management SIG have worked hard on developing a guideline to help manage patients with aggression issues in the ICU. The plan is a multi-disciplinary effort with medical, nursing and SSA. Numerous consultations with groups such as Psychiatry, Occupational Violence, and Pharmacy have been made and the plan have been through a lot of committees.

The SIG through the impeccable leadership of Karen Kicker and Jacqui Regan have developed an Aggression management chart/matrix. A risk aggression indicator have already been added into ICCA. Staff trainings have commenced particularly on dealing with Code Greys.

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Many Thanks to Karen

WHAT IS A DPC?

DPC means Distal Perfusion Cannulae.

It is also called the Backflow Cannulae.

It allows for antegrade flow down the leg, and retrograde flow into the area between the return cannula and the distal perfusion cannula.

From the Alfred ECMO Guide Presented by Peter

A distal perfusion cannula is routinely placed for patients receiving femoral VA ECMO support to prevent leg ischaemia.

In any case, a distal perfusion cannula should be placed as early as feasible, within 6 hours of initiation of femoral VA ECMO support.

ECMO

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Hourly leg vascular observations are performed, noting: Colour

MONITORING OF DPC

Warmth Presence or absence of dorsalis pedis and posterior tibial pulses by palpation or Doppler assessment (the site of the loudest Doppler signal should be marked on the patient with a cross) Flow in the distal perfusion circuit

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When used, NIRS pads should be applied bilaterally to the mid-calf early post VA ECMO initiation to obtain baseline values.

Suggested thresholds for clinical concern have varied between studies and manufacturers. In a study of the INVOS system (Coviden Somatics) an rSO2 < 40%, or more than 25% below baseline, was considered significant (Wong, Smith et al, 2012).

CORNER

From the Alfred ECMO Guide Presented by Peter

Peripheral tissue oxygen monitor Near infrared spectroscopy (NIRS) is used in many centres for cerebral monitoring of patients undergoing cardiopulmonary bypass for cardiac surgery, while its role in monitoring of limb perfusion and/or cerebral perfusion in ECMO is less established.

ICU Staff Profile Tell me a little about yourself and your family.

HAO

I originated from Zhengzhou, a city in China renowned for its deep cultural roots, especially in the realm of traditional martial arts. I spent 26 years immersed in the culture of my hometown before venturing abroad to broaden my horizons. This quest for new experiences led me to Sweden, where I lived for five years and met my partner, Eva. Our union in marriage was a significant milestone during my time there.

In late 2019, a career opportunity prompted our move to Melbourne. Although the transition was challenging, particularly with the onset of the COVID pandemic, we have successfully settled in this dynamic city. Our family grew with the addition of Frankie, our playful and spirited dog, who joined us in late 2022. He is now a lively and mischievous companion, bringing a unique joy and energy to our lives. This journey, encompassing cultural exploration, personal development, and the happiness of nurturing a pet, has made Melbourne feel like a true home.

How long have you been in your current role and how do you like working in the ICU? Time has certainly flown since I joined the ICU team in May 2023, and it's been an incredible six months so far.

The initial weeks were bustling with activity as there was much to learn and absorb. I feel fortunate to have the support of the ICU team; their encouragement and readily offered assistance have been instrumental in helping me quickly adapt to my role.

My position as a Clinical Data Analyst presents a unique experience, distinctly different from my previous roles.

While I spend a considerable amount of time at my desk, engaged with computers and coding, this role also involves significant direct interaction with clinical staff.

It's truly rewarding to see firsthand how my work supports the staff in their duties. This direct engagement is a distinctive aspect of my role, one that I have thoroughly enjoyed and found fulfilling.

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Interviewed by Peter

ICU Staff Profile Where did you work prior to your current role?

My professional journey began in China, where I trained as a medical doctor and subsequently worked as a hospital medical officer for three years. My growing interest in medical research then steered me towards academia. Over the past eight years, I have devoted myself to research as a PhD candidate and postdoctoral scientist, with a focus on the genetic basis of gastrointestinal diseases and the application of biostatistics in analysing large-scale health data. Throughout this time, I was consistently drawn towards integrating my clinical experience with research. The current role in ICU marries my diverse skill sets in medicine, research, and data analytics seamlessly, allowing me to contribute meaningfully in a clinical setting.

What do you like to do in your free time?

HAO

In my leisure time, I find great enjoyment in activities that offer both relaxation and new experiences. A favourite pastime of mine is outdoor activities with dogs and exploring antique shops. The thrill of discovering unique and historical items is truly captivating. Recently, I've started to broaden my horizons by delving into new hobbies such as fishing and learning to play the piano.

Can you share any inspirational quote or experience?

In my journey, both personal and professional, I've found immense inspiration in a quote by Helen Keller: "Life is either a daring adventure or nothing at all." This statement deeply connects with my own experiences, particularly in the context of moving between different continents and cultures. Embracing this perspective, I embarked on a journey that took me from China to Sweden, and eventually to Melbourne. Each relocation brought its own set of challenges and opportunities. In Sweden, not only did I adapt to a new culture and language, but I also found love and companionship. Moving to Melbourne, amidst the unpredictability of a global pandemic, tested my resilience and adaptability. These experiences have taught me the value of embracing change and finding strength in adversity.

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Interviewed by Peter

SUCCESS STORIES Thriving post cardiac arrest POSTED 13 NOVEMBER 2023

by Steve Musca

Dylan

RAVINDER The day Ravinder walked back into the ICU feeling like a new man, he was filled with gratitude and respect for the staff who helped save his life. Ravinder’s story started with sudden chest pain followed by multiple prolonged cardiac arrests and interhospital transfer, ending up at St Vincent’s Melbourne.

He spent over 2 weeks in the ICU which included coronary artery stenting by a Cardiologist, pneumonia, more cardiac arrests and a very shocked heart to name a few of his struggles! Once he emerged from these life or death battles he proceeded to having a pacemaker and defibrillator device inserted.

Several months down the track and he is now walking 5-7km per day and has a new lease on life.

Thank you Ravinder for returning to visit us in the ICU and we wish you all the best from here.

11 From Steven Musca’s STV ICU Blog

SUCCESS STORIES The man with more than 9 lives POSTED 13 NOVEMBER 23

by Steve Musca

KASHIF 47yo Kashif was transferred to St Vincent’s Melbourne after a large heart attack and was found to have severe coronary artery disease, requiring open heart surgery. Whilst Kashif already had some significant risk factors such as being on long term dialysis, no one could have predicted the stormy course his admission would take.

Kashif suffered a cardiac arrest shortly after his open heart surgery requiring application of a special therapy, ExtraCorporeal Membrane Oxygenation (ECMO), whilst he was getting internal cardiac massage as his heart was not pumping. This machine circulated blood and oxygen around his body, effectively keeping him alive.

Over the coming days, he had multiple further heart operations to help him continue on, all amongst the uncertainty of how his brain would recover after a prolonged period of low oxygen supply. It was touch and go many times for Kashif, but he somehow soldiered on. He managed to be liberated from the ECMO machine but needed a tracheostomy inserted as his muscles had become very weak.

Fast forward 2 months later from his admission to ICU and Kashif had miraculously recovered normal brain function, complete with an incredible personality. He was breathing well for himself and his heart was strong enough to be off all infusions and machines. This photo was snapped before he transitioned to rehabilitation to strengthen his body for a return home.

He reflected that it is very strange to have so many people know about his journey, despite not being able to remember himself. He wanted to thank everyone who cared for him and was looking forward to the next part of his journey. What a journey it has been!

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From Steven Musca’s STV ICU Blog

SARAH CLARA WILL STEVE ELLA IVAN

13 Many Thanks Sarah Horsfield

BOWLING FUN FOR EVERYONE! 14 Many Thanks Manisa & Nellie

RECIPE CORNER Method: 1. Cook pasta as per instructions, salt the water 2. Peel garlic, remove kale stems and add to cooking pasta when 5 mins remain 3. Use tongs to transfer the kale leaves and garlic to a blender or nutri-bullet. Add slurp (3 tbs) of olive oil, lemon and parmesan

Green Pasta Perfect for a mid-week meal serves 4 ready in 20 mins

Ingredients: 300g spaghetti as much garlic as you can be bothered peeling 400 g kale 60 g Parmesan cheese, grated 60 g ricotta cheese squeeze of lemon

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and blitz for a few minutes until super-smooth. Season with salt and pepper to taste.

4. Drain the pasta, reserving a cup of the pasta water 5. Return it to the pan and toss with the sauce, adding some of the pasta water to thin., if needed 6. Dot over the ricotta, drizzle with a tiny bit of extra virgin olive oil, chili flakes and ENJOY!

Written by Esther

ALTERNATIVE ICE CREAM PLACE Grey ice cream? Is it black sesame? Is it activated charcoal? We may never know, unless we try it!

The current MPAVILION architectural display offers gray ice cream for you to try. They have six different flavour sets in six shades of light gray to almost black.

This was the brainchild of Brazilian artist João Loureiro. In collaboration with Piccolina Gelateria, the display will be open until the 28th of March 2024.

Please visit Queen Victoria Gardens opposite the ARts Centre on St. Kilda Road, Melbourne.

16 Compiled from the MPavilion website and Instagram

NEW NURSING STAFF!

MONISHA

MINI

MEET SOME OF OUR RESIDENTS

CAITLIN

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JEN

DANIEL

ELISE

GRETA

JON

RYAN

WARREN Many Thanks Manisa

TIPS ON LOOKING AFTER NEUROSURGICAL PATIENTS POSITION HEAD AT LEAST 30DEGREE WITH NECK NEUTRAL POSITION PACO2 35 TO 45 MMHG AVOID PYREXIA & ANDHYPERGLYCAEMIA APPROPRIATE SEDATION 18

Written by Sunil

AS SEEN IN SOCIAL MEDIA

19 Taken from SVHM Facebook Page

AS SEEN IN SOCIAL MEDIA This year, Planet Ark’s National Recycling Week is themed ‘What goes around comes around’.

It’s all about high quality segregation practices so that our recycling can become part of the circular economy. We don’t want our efforts to go to waste.

Soft plastic is a big problem in Australian hospitals, particularly in theatres and the Intensive Care Unit (ICU), where sterile procedures generate a particularly large volume of soft plastic waste.

But a cutting-edge and collaborative, six-month trial, is allowing SVHM to recycle about 40 kilograms per fortnight.

The initiative has been led by Karl Askew, Associate Nurse Unit Manager, and his team.

SVHM has partnered with APR plastics to turn plastics into oil. APR use a pyrolysis method which provides a circular solution for plastic waste.

The chemical reaction happens in a completely sealed system, resulting in little to no emissions compared to traditional disposal methods such as incineration.

The oil created is sent to a refinery to be further processed so it can be reused in food-grade plastic products.

It means a waste resource becomes feedstock for a product, and back to a resource – so it has circularity.

Waste plastics targeted include items from ventilators housing and unsoiled gowns.

“Clinicians have responded positively and are communicating to understand better exactly what can go into soft plastic recycling,” said Karl.

“Thanks to the trial, we’re now incorporating the process into their workflow and without too much interruption - at the end of the shift, we just drop the bag in the soft plastic skip.

“Our biggest challenge to expand recycling in the hospital is finding storage space.”

Other tactics being used in ICU/theatres include: Further recycling streams including PVC. Repairing and maintaining furniture (including reupholstering).

Rehoming / diverting expired or superseded consumables and equipment such as hover bed mats and pumps are donated to developing countries such as Sierra Leone.

Reconfiguring bins to discourage over-reliance on clinical or general waste.

A switch to rechargeable batteries.

20 Taken from SVHM Facebook Page

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Send in your snaps! s t e p e v Festi Send in a pic of your fury friend dressed up for the festive season

? o h w s s e Gu

Send in a pic of you as a baby (up to 4 years old) and we will release in Dec edition of the Pulse to see if your collegues can guess who is who!!

Pictures due December 3rd

email: thepulseicu@svhaorg.onmicrosoft.com 23

24 From the ACCCN Website

EDITORIAL TEAM Editor-in-Chief Crystal Park Main Issue Editor Peter Andrew Garcia Managing Editors Esther Fulton-Grigg Grace Wilkinson Sunil Joseph Thank you to the following contributors: Vicky Jones Nellie Nixon Manisa Ghani Karen Kicker Steven Musca Zheng Tenghao Karl Askew Sarah Horsfield 25

Have an interesting ICU story to tell?

Please give us a shout!

Our email is at thepulseicu@svhaorg.onmicrosoft.com

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THANK YOU!

From the Fishsidegallery Instagram

Is your fur child lonely on your long days at work? Need a holiday but can’t take your dog?

Kate is an allocator for NWU. She & her 3 housemates are dog sitting at their home in Fitzroy North. They offer doggy day care OR overnight dog boarding. Scan the QR code for more info!