[oshieee]

It is good you admitted to the fault but you would have explained what you did immediately too. in the future, you should ask about drug administration if you have even the slightest doubt that you might be wrong. or just ask to be certain before administering medication. it is not a crime because we need guidance always. luckily it was not fatal

A similar thing happened to my classmate and she was cautioned and allowed to continue the program. am a 3rd yr nursing student. be careful all the time. goodluck.

[juliarn]

I programmed NS as primary at 30cc/hr , VTI 30cc, and hepain as a secondary 32cc/hr, VTI 500cc.

Hi,

You'll have to excuse me, I'm an australian rn, and not sure of the abbreviations but...if NS is normal saline. how could you ruin the patients vein?


secondly, the ward you are on should have a manual of policies, which tells you how to do certain things, eg. heparin infusions. I know at my hospital, you'd need another RN to check what you are doing. You seem to have been left high and drive and that's poor on their behalf.
Please post as to how you go. You will be feeling bad but we've ALL made mistakes. Hang in there

[oshieee]

As a nusing student we are always supervised by an RN, so if that is done, so many mistakes can be avoided. also we must learn to ask when not sure...thanks for your post and encouragement.

[nursekare]

I believe that the first thing that you need to do is obtain and read the hospital policy/protocol for heparin administration.

If you can determine from the policy that you indeed violated it by your action or inaction, you must take the write-up like the professional that you are.

If it is determined that policy wasn't violated, when asked to sign the write-up document refuse to sign it and ask for a copy of the document, if you intend to seek legal representation, to give to your attorney.

If an attorney isn't in the cards, write your reasons for refusing to sign it somewhere on the document and return it to the manager of the unit. That way your side of the story is available for anyone examining your employee file to see and understand your side of the situation. This will come in handy if you transfer to another area of practice within your facility.

Start the written refusal to sign with something like this;
I, [insert name here], refuse to sign this document. Then proceed with your version of events.
I hope this gives you some clues as to how to handle the situation.

It is good nursing practice when performing a proceedure or task for the first time to determine if there is a protocol that must be followed and/or a hospital policy that one must adhere to.

Ask your fellow staff members. If you don't feel comfortable with their advice, look up the policy yourself and read it.

If you still don't feel comfortable, call the covering house supervisor for further advice on the situation.

Often times nurses in the specialty areas [ED, OR, ICU, CCU...] can be helpful in certain situations, use all available resources when not sure when performing a proceedure for the first time.

Keep your chin up.
The only nurse that doesn't make a mistake is one who doesn't report their mistakes and/or hasn't been caught making a mistake by a staff member who would report it to those in authority.

[walk6miles]

Are they writing you up, or just calling you up and making STUPID statements? This is the dumbest thing I have ever heard!!

A central line is always the preferred access in an icu setting but if you have to go peripheral since they won't give the patient a central line, it is acceptable to run Heparin with NS..... you know the rest of the story....

Ask for a meeting within the chain of command.....keep us posted!

[MissMonica]

What happened to the DIKH (Did I Kill Her) rule? Digoxin, Insulin, Potassium (K+), and Heparin. You check with another RN when you administer, every time. Sounds like the mistake could have been caught but I agree its too late for blame, just learning. I am sorry to hear your employer is leaving you freaked out instead of using this an example in an update/inservice etc. I also agree with others...how can NS ruin a vein, particularly at such a low infusion rate?
If I were you, at this point I would get all my info in order: find your facility's policy on heparin administration and also review heparin drip in your nursing texts/notes and make sure you are covered since they are going through with an investigation.

What I appreciate about a mistake (provided they arent fatally harmful) is that you would probably never make a mistake with heparin drips again after this, and therefore be a better nurse. I hope your employers realize this.

[Anne2006]

All good nurses make mistakes. Great nurses never make the same mistake twice. Ask for a clear explanation of the error you made and how you should have performed. Once you fully understand it and know with certainty that you can do it correctly, FORGIVE YOURSELF!

[mary RN97]

First of all, Normal Saline does not ruin the veins. Heparin hung as a piggyback is not a dangerous thing. Its just not therapeutic. I can't believe your DON made such an issue about this. That is crazy. Man she would have a cow, a horse and a goat if she worked at our hospital. This really does not make any sense at all. The patient probably needed a central line because of no veins. But you are certainly not the cause........TRUST ME.

[astro_7]

I'd like to add a little input here. Maybe I'm just reading a little too much into it but as everyone else has said here, NS will just not ruin a vein. The only thing I can imagine is that the (clogged?)AVF was being kept patent with the heparin, and with the NS running instead of the heparin, it clogged up. Is it possible that the AVF was the "vein" that was "ruined" and not the actual vein with the PIV? I would think that ruining a patient's AVF, especially one with poor veins, would cause plenty of people to be upset.

[RUnotentertained]

I haven't posted very often at the site, but this made me have to chime in with my opinion and thoughts after 25 years of being a nurse. So many things sound to have been done wrong here.

Many have been pointed out already. Normal saline does NOT ruin a vein. The patient had poor venous access to begin with. I work at a transplant teaching facility and this patient would have had a PICC line a long time ago as would be appropriate or a central line. Secondly all nurses make medication errors. We hate it and try to prevent them, but we make mistakes. We shouldn't eat our young (this young nurse) and try to beat her over the head for the error. Give her the education and counselling to prevent a future mistake. You don't suspend her.

Fix the problem! Inservice!

If it helps at all the first bad error I made was with heparin. It was to be increased because of the patient's PTT and I calculated the rate innappropriately. Luckily it was found and there was no harm to the patient, it just took longer to reach the therapeutic level. I was a young nurse then too. You never forget. It was 20 years ago at least. It was before Heparin was double checked with another nurse and now heparin is usually a standardized concentration. A drip rating list should be posted in the medication room.

They need to counsel you and give you something to read and sign if they are suspending you. This is several days old. I hope it has been resolved for you by now. I'm so sorry you've gone through this. No wonder the average age of an RN is 46.1 (ha, I know it's down from 46.7). We drive nurses away instead of making them better nurses! Hang in there.