[heavenlee78]

helppp.. I work in icu. i had a patient on levophed running in a peripheral line in the left ac. at about 0500 i noticed the patients fingers distal to the site were cyanotic but the site itself was patent with blood return noted. I attempted to turn the levo off because it was such a low dose anyway. The patientss bp dumped. i called my charge nurse in to look at the hand. i then proceeded to start a new iv in a new limb at 0700 the new shift came in I reported to the nurse the problem and what I had done. the following week i am called in with others for a meeting regarding the pt's condition in the hand. i found out the doctor did not find out about the problem for three days and this pt may lose his fingers. I found out the doctor put in her progress notes my name and that i was the cause of this problem. I am very upset. please let me know what i could have done different and what to do about this doctor.

[Michigan RN]

The patient should have had a central line to begin with if they needed to run levo. Levophed is a very potent vasoconstrictor with one of the risks being that it can cause severe peripheral and visceral vasoconstriction which will eventually lead to tissue hypoxia. The doctor should not have put your name in the progress notes. Fault lies with everyone. When you noticed the cyanosis, the doctor should have been notified. But if you hadn't called the doctor, the next nurse who took care of that patient should have.

I don't know how long the patient had the levo running but I've seen patients that have lost fingers after having had levo in ICU. I can't imagine that you would really get in trouble. The levo saved their life did it not?

Next time you notice something like that or anything abnormal, call the doctor.

[sharrie]

Hi there and welcome to the site.

I am sorry you are having a difficult time and I would tend to agree with the above poster, we would never give Levo via a peripheral line it would always go via central access.

One of the effects of having a patient on Levo is that their peripheral circulation can become compromised and they can end up with black fingers and toes. It is a risk that the docs take when they start the drug.

What did your charge nurse say when you reported to her / him

[heavenlee78]

Originally Posted by Kati2005

The patient should have had a central line to begin with if they needed to run levo. Levophed is a very potent vasoconstrictor with one of the risks being that it can cause severe peripheral and visceral vasoconstriction which will eventually lead to tissue hypoxia. The doctor should not have put your name in the progress notes. Fault lies with everyone. When you noticed the cyanosis, the doctor should have been notified. But if you hadn't called the doctor, the next nurse who took care of that patient should have.

I don't know how long the patient had the levo running but I've seen patients that have lost fingers after having had levo in ICU. I can't imagine that you would really get in trouble. The levo saved their life did it not?

Next time you notice something like that or anything abnormal, call the doctor.

THANK YOU YOUR MESSAGE. IN OTHER FACILITIES I HAVE WORKED IN LEVO WENT CENTERALLY ALSO. MY CONCERN IS WITH THIS DOCTOR AND THE FACT SHE NAMED ME IN THE CHART. WHAT SHOULD I DO ABOUT HER

[Michigan RN]

Originally Posted by heavenlee78

THANK YOU YOUR MESSAGE. IN OTHER FACILITIES I HAVE WORKED IN LEVO WENT CENTERALLY ALSO. MY CONCERN IS WITH THIS DOCTOR AND THE FACT SHE NAMED ME IN THE CHART. WHAT SHOULD I DO ABOUT HER

First, please turn off the caps lock on your keyboard. Secondly, there is nothing you can do. The doctor is not going to alter their progress note.

[heavenlee78]

Sorry I did not realize the caps would upset you so. It is the least of my concerns. I know the chart is not going to change. As you said all are at fault in some way here. I should not have to take the fall by myself. What this doctor did in very unprofessional not to mention unfair. I was looking for legal advice not common sense. I do appreciate your input.

[heavenlee78]

Thank you for your response. My charge nurse did not have a lot to say. I told her I was going to move the IV and she agreed. While I made the mistake of caring for the patient first before calling the MD, I do not feel I am the cause of this injury. I truly did not expect her to not find out for three days.

[sharrie]

Originally Posted by heavenlee78

Thank you for your response. My charge nurse did not have a lot to say. I told her I was going to move the IV and she agreed. While I made the mistake of caring for the patient first before calling the MD, I do not feel I am the cause of this injury. I truly did not expect her to not find out for three days.

It sounds to me as if there were as you say a number of people involved in the decision to allow the levo to run peripherally. However patient changes should have been reported to the MD, I take it you documented these in your report. Does the MD not visit daily, do they not read the nursing reports. We have collaborative notes so we all write in the same place.

We are lucky in the UK, this would be investigated and all members of staff involved would be asked provide input into the situation, there would be a unit action plan to prevent a reoccurance and if any retraining was required this would be addressed with the practice development nurse.

Originally Posted by heavenlee78

Sorry I did not realize the caps would upset you so. It is the least of my concerns. I know the chart is not going to change. As you said all are at fault in some way here. I should not have to take the fall by myself. What this doctor did in very unprofessional not to mention unfair. I was looking for legal advice not common sense. I do appreciate your input.

We are not able to give you any legal advice at allnurses.com it is a breech of the terms of service. Whilst I am comfortable letting you ask advice on the situation with the patient, if it is legal advice that you are requesting then the thread will be closed.

As you have specifically said that you are looking for legal advice I am going to close this thread as it would in inappropriate for any member here to give you the advice that you need. It is something that you need to discuss with an attorney.