frustrated...bad 2 days

  1. Just wanted to talk about it. Had a pt, post CABG. Still had IJ multi med line. Protocol is to pull the MML after securing a peripheral IV. I tried 2 sticks, didn't get it. Then I asked another nurse to try for me. She went in there, came out and said she got it, a good one, #20 in the hand. So i went back in and hooked up the fluids, and all was well and good. Seeing as the IV was good, infusing, etc, I pulled the MML. an hour later, family calls out, the IV is leaking. I tried to flush it, but hte flush went all over the bed, etc, b/c the IV was completely out of the vein.
    So then I called the resource nurse (the ones we call for hard sticks). She came, tried 2 sticks and they both blew right away, so she said "call the doc" and left. ARRRRGGGHHHH.
    I called the PA first, who seemed frustrated, "well, we need IV access, what are we going to do?" and b/c it was a weekend "well, i'm not coming back in for an IV" and finally said if we couldn't get anyone to get it, then just leave it, and he'd get it in the morning.
    well, the surgeon on call was on the floor.je was having a bad day. i mentioned it to him. he said a few unmentionable words and went to look. He admitted the guy was a hard stick, and tried twice himself. asked "now why did you pull the MML?" and I said that the IV was good. THen was not happy, told me to go get teh central line kit. I was freaking out inside-i've never assisted with that, didn't want to screw up and not do it right-he was already in a bad mood and i didn't want to get fussed at. when i came back w/ the kit, he'd gotten one in.
    so then i felt totally stupid. how did i let that happen???

    then, same pt, next day. took staples out of leg incision per order. steri stripped. it was fine. few hours later, he calls out b/c his leg is bleeding. his incision was starting to open up. Did i not steri strip it enough? i even watched it as i pulled out staples-it was staying closed!


    I just felt so bad about it all. What did I do wrong? Should I have done something different? I guess in the end, it'll be a good expereince for me to look back on and learn from, but right now it sucks.
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  2. 9 Comments

  3. by   jenrninmi
    Don't beat yourself up over these things. It sounds like you did what any other nurse (even experienced) would have done. Not your fault the iv went bad. Also sounds as if the patient must have been moving around a lot for the incision to start bleeding again. How did you fix that problem, by the way? Did you apply more steri strips?
  4. by   truern
    HappyNurse, sweetie these things HAPPEN!!

    You did the best you could do....the IV was patent, you pulled the line...per standard protocol. There was a MD order to pull the staples (I'm assuming he/she thoroughly inspected the incision, right??), you pulled them and applied steristrips, the incision looked fine until later.

    I'm just not seeing where any of this is somehow your fault...no matter how hard I look
  5. by   HappyNurse2005
    UPDATE:
    i went back today and had that patient again. yesterday, while i was off, he had that leg would that opened up debrided and stapled/sutured back up and a Blake put in it.
    fun.
  6. by   DeLySh
    I know this is a weird question to ask but is it at all possible that the pt was causing these complications purposefully? It just sounds weird for this to happen to the same person and I do know quite a few people these days who would do such a thing.

    DeLySh
  7. by   luvltc
    I was wondering the same thing as DeLySh. We hate to pass judgement on our patients, but last night I has a very alert and oriented 80 year old lady who, over the course of my 12-hour shift, pulled the dressing off her chest dialysis catheter 3 times. :angryfire Knew exactly what she was doing, just "felt like doing it". She also, during day shift, had pulled the dressing off 6 times over a 12-hour shift. As it is, this lady had had a severe infection in a previous dialysis port. Unfortunately, our hospital does not allow restraints just because the patient is a pain in the a**.
  8. by   babynursewannab
    Hmmm. Pain in the a** isn't a legal reason for restraint, but unable to comply with medical treatment, picking/pulling at lines, and endangering self (grossly increasing risk of infection along with history) are legal reasons. It is a sketchy line, though.

    Are you 100% sure about her psych status?
  9. by   DusktilDawn
    Quote from 5scardiacnurse
    I was wondering the same thing as DeLySh. We hate to pass judgement on our patients, but last night I has a very alert and oriented 80 year old lady who, over the course of my 12-hour shift, pulled the dressing off her chest dialysis catheter 3 times. :angryfire Knew exactly what she was doing, just "felt like doing it". She also, during day shift, had pulled the dressing off 6 times over a 12-hour shift. As it is, this lady had had a severe infection in a previous dialysis port. Unfortunately, our hospital does not allow restraints just because the patient is a pain in the a**.
    These are the ones you document very carefully on. Each time you re-educate, each time they repeatedly do the same thing.

    I also wondered if possibly HappyNurse's patient may have just been careless (I've seen a lot of people not exactly careful when they have IV sites). It is possible the patient may have inadvertently opened his incision through movement.
    Last edit by DusktilDawn on Oct 12, '05
  10. by   wolfnurse
    Hang in there. Things happen.
    Take the experience and run with it professionally and learn from it.
    I myself wonder after reading the responses if the patient is doing something with the IV. When i practiced on a Medical/Surgical Unit sometimes i wonder if some behaviors and actions were encuraged by family members. I have had my share of patients that admited to me doing things that were harmful despite repeated warnings.Good documentation is a must

    Blessed Be
    Wolfnurse
  11. by   Daytonite
    Been there, too. There are alternative peripheral sites to try: the Basilic vein in the back of the forearm or a branch of the cephalic or basilic veins ABOVE the antecube. It is often easy to see these veins in men. These are larger veins than the ones in the hand and will hold an IV well. There were times when we weren't sure that a periperal IV was going to hold so we just capped off the IJ or central line, flushed them with saline or heparin (whatever the heparin/saline lock protocol is). That way, when the doctor visits next he can write an order to remove the IJ or take it out himself. Either way he's the one that ends up taking the responsiblity if you can't get a peripheral line in, got it? That's probably the safest thing to do next time if the IJ site isn't phlebotic. You can do the same with subclavian lines. If you get flak about it just say that you wanted to make sure the patient had an IV access and you couldn't be sure the peripheral line was going to hold. Heparin (or saline) locking any IV instead of taking it out is always OK if the site looks alright.

    Regarding the patients leg incision. . .I've seen this happen before in post-op CABG's. They ended up with post-op infections in these wounds. Who knows why? It's possible that circulatory problems or obesity may be the cause. Sometimes post-op infections just occur. It's one of the risk factors of surgery that the doctors are supposed to explain to the patient before surgery. This wound would have strained at the staples and attempted to open up on it's own anyway--the wound needed draining. None of this was your fault.

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