July 7, 2007, 1:25 am

Smack the IVAC!



That is one long stethoscope!

You could stand outside the room, throw in one end and listen from the hallway!

It’s been my experience that the longer the tubing, the less I am able to discern breath sounds.

I thought I was going deaf from too many rock concerts until I bought a more expensive stethoscope that is just barely long enough to go around my neck. Breath sounds were clearer. Heart sounds were clearer. No more of those cheapie Littmanns for me (that’s no dis of Littmann, my upgrade was the Littmann Master Cardiology).

My doc had a stethoscope that was electronic. I checked it out. $800! I would love to have it, but I have learned from painful experience that the more expensive the stethoscope, the more likely it is to “walk”.

I’ll treat myself to it someday when I figure out how to weld it to my body…


The Nursing Voices forum is off to a great start!

By popular demand, we have added categories for advance practice nurses and faculty/research. I know from my BSN classes that many nurses are going back to school to allieviate the shortage of nursing instructors so any expertise in teaching or research is greatly appreciated!

There are many new nurse bloggers and some are submitting to Change of Shift for the first time. Emergiblog is almost two years old and during that time there has been an explosion of nurses blogging on the internet. From the pioneers like Code Blog: Tales of a Nurse and Mediblogopathy to the new (to me!) nurse blogs like Counting Sheep and This Won’t Hurt a Bit.

Totally cool.


Emergency departments are noisy places. With all the people around hustling and bustling, you can’t even hear yourself think.

In the midst of all, you hear it.

Beep. Beep …….Beep.

Somewhere, somehow, someone conducted research to find the most obnoxious sound occurring at the precise interval at the perfect pitch to drive registered nurses out of their minds.

Then they installed it.

In the IVAC.


Some of my colleagues are highly sensitive to this repetitive warning that something is not right with an infusion. They can sense an alarm before the sound waves are even generated.

They sit straight up, head slightly tilted, muscles tense with anticipation of rapid deployment.


The machine does not make another sound.


I don’t ignore the alarm, I check out the problem. Downstream occlusion. Upstream occlusion. Whatever.

I don’t necessarily silence it when I’m trouble-shooting.

I probably should, just so my colleagues don’t think it is being ignored. For some reason it doesn’t drive me batty.


Now the alarm on the cardiac monitor is another thing altogether.

Our monitors sit high above the nurses’ station. It alarms. 99.99999% of the time it is artifact. But until the alarm is “silenced” by pushing a button it will ring. And ring. And ring. Not loudly. Not obnoxiously. Consistently, at a pitch that hits the brain just above the level of conscious thought.

Meaning it is easy to ignore once you have ascertained that there is no problem to address.

And so the game begins.

Three nurses and a doctor sitting under the monitor, which is making regular, persistent, mid-range hooting noises.

And no one moves.

A test of the will has begun.

Who can go the longest without “breaking” and silencing the electronic beast? Ironically, the same nurses who play “smack the IVAC” before it beeps twice are immune to the maniacal monitor monitone.

I usually win the contest because I push the repetitive noxious noise deep into my subconscious, causing fellow nurses to break before I do. Of course, if I’m sitting right under the monitor, one of my colleagues will politely ask me to please hit the damn BUTTON!

Huh? Oh! Sure…. (Tee hee! I win!)


Well, now they have made sure that the IVAC is audible to everyone and everything short of XM Satellite Radio.

Before you can open the machine to insert the IV tubing, you must conduct a “speaker test”. You press a button and a blast of sonic disturbance emanates from the infusion pump. Did you hear it? The machine asks you that! And if you did, and believe me you do, you must push the “Yes” button to continue.

(I wonder what happens if you push the “No” button?)

I know it’s for safety.

It’s also loud and obnoxious and another step in the ever increasing amount of minutiae we have to observe, document and perform each day.

So what else is new?


I’m using the term IVAC as a general name for an infusion pump. Not all infusion pumps are IVACs. We happen to use Baxter pumps, but that didn’t sound as good in the title!


  • Mother Jones RN

    July 7, 2007 at 4:29 am

    I’d rather listen to the rantings of a raging psychotic patient than the insistent beep-beep-beep of an IVAC machine. Oh yeah, Baby, smack the IVAC!


  • Faith

    July 7, 2007 at 4:45 am

    Oh my god, the IVAC beep, the most annoying noise ever- second only to the patient buzzers!

  • Terry

    July 7, 2007 at 4:51 am

    In the OR, there are so many different beeps that part of your training includes “getting to know your beeps.” Between you ventilator and the anesthesia monitors, there are a minimum of two dozen different alarms, and that’s not including the beepbeepbeep of the pulse ox that is your constant background music!

    And then there are the OR beeps…..

    Whole lotta beepin’ goin’ on!

  • Deb

    July 7, 2007 at 7:19 am

    That kinda makes sense, though I’m not a nurse or medical professional. Like when we used to take a cord and attach it to a paper cup (making a telephone), the longer it was the harder it was to “hear” what was being said.

  • somedaynurse

    July 7, 2007 at 10:12 am

    In our ED, we as volunteers weren’t told what any of the beeping means. The first time a patient yawned real big and that o2 stat bell went off, all I remember thinking is how I wanted to run away so I wouldn’t be in the room when she died.

    I took the next slow moment as an opportunity to have a tech walk me through all the bells and beeps, not so much for me, but because I wanted to be able to explain the different sounds to patients and their family. If it freaked me out, imagine how that old lady must have felt when the monitor started flashing and screeching.

  • Awesome Mom

    July 7, 2007 at 10:21 am

    Silencing alarms was one of the first things I learned how to do when Evan was in the PICU, not that I ever did it, but I could have. Those things are pernicious and really get under your skin and into your head.

  • BabsRN

    July 7, 2007 at 11:16 am

    The Littman Master Cardiology is a good one but HEAVY. I always had a sore neck at the end of a shift.

  • marachne

    July 7, 2007 at 11:56 am

    The thing that makes me crazy is going into a hospital as a visitor and hearing the pumps going off — I have to work so hard to suppress the urge to go in and see why it’s beeping! We just switched from the old Baxters to Alaris pumps. Those things are wicked cool! I love the fact that you just add modules to add channels, and the preprogrammed “library” of meds. I was also amused to hear that the committee that worked on the meds library had a bit of a heart attack when we (the hospice/palliative care unit) asked them to program for us — they had a bit of a hard time getting their head around morphine rates of oh, 50 mg/hr with 15 mg PCA rates Q20 minutes — you really do get a warped idea of “normal” when you’re doing EOL care. But then, every specialty has that whether it’s WBC counts in the teens for oncology folks or crazy low ejection fractions for those heart failure types.

    As for stethoscopes, one thing I am amazed at is when I see people with the double tubed ones — seems like too much noise comes from the tubes hitting each other. I went middle of the road with the single bell Littman Master Classic II — not as sensitive as the cardiology, but pretty darn good!

  • JohnS

    July 7, 2007 at 5:28 pm

    Are there any recommendations or reviews for electronic stethoscopes? I’ve been searching, and I see a lot of repetition at sales web sites of info from manufacturers, but I can’t seem to find and real experience with any models.

    $800 is out of reach, but I’m ready for $3-$400…

    -No- pump alarms are almost worse than one going off; the tension builds…. which room? whose pump? Soon, soon ….

  • NPs Save Lives

    July 7, 2007 at 7:53 pm

    I have a highly tuned sense of hearing and the constant beeping of alarms used to drive me insane because people would ignore them. ARGH! I would rather they take care of the pump and fix the problem and not have to call me to restart an IV on a difficult patient. Now that I’m not working in the hospital, the quietness is almost deafening! Go figure!

  • Jen

    July 7, 2007 at 8:01 pm

    From personal experience: the more expensive the stethoscope, the more likely your dog is to eat it…..

  • Dr. Wes

    July 8, 2007 at 9:27 am

    Glad to see you’re still using a stethoscope – most interns these days are just getting an echo…

  • Melissa

    July 8, 2007 at 5:13 pm

    I’m one of those poor sensitive souls that must stop all beeps immediately. It’s no contest, I’m always the first to fly off my chair to silence a beep. If I can’t stop the beeping, I’m so tempted to throw the machine against a wall or over the balcony. I need quiet.

  • […] Smack the IVAC, Kim of Emergiblog humorously expounds on stethoscopes, a new nursing forum and obnoxious alarm […]

  • Nurse Betty

    July 9, 2007 at 10:32 am

    When I worked ICU, sometimes after a busy evening shift I would find myself kind of sleepwalking through my apartment in the middle of the night, trying to find the IVACs that were still beeping in my brain. Cannot stand that noise–it MUST be silenced at all costs.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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