Here's the trouble. A fellow nurse of mine tonight received a renal patient from ER with an amioderone drip running at her AV fistula site. Now this nurse knows since we are not trained to deal with AV fisutulas, not to touch it period. MD writes an order to discontinue using AV fistula and start peripheral IV. What should this RN do?
The RN started a peripheral IV and is waiting for tomorrow when the dialysis nurse shows up to switch over IV sites.
Jan 21, '07
If the ER doc okay'd the drip to be run via the shunt and the admit doc knows, she may not have had any other choice. A PICC is necessary however, getting a STAT one placed may be difficult if there is no one to put one in ( we wouldn't get one until the next day ) . Why didn't the ER doc put in a central line? Doesnt' sound like she touched it anyways. From what I gathered, she left the lines as they were when the pt was transferred from ER. Doesn't sound like she was gonna pull anything out even though the MD ( I'm assuming the renal guy) told her to pull it and change over to the piv. I would have left the "setup" as it was and let the dialysis nurse deal with it in the am providing the MD's knew the situation. ( and charted by butt off ) He probably had crappy veins anyways and if he was critical enough to need a drip, then i'd rather have that access than running the risk of multiple piv's blowing and the pt crashing from not having the drip.
Last edit by lashes on Jan 21, '07
Jan 21, '07
Quote from Mulan
I would think that there would be a dialysis nurse on call that could come in and deal with it then, not in the morning.
Did the nurse consult the house supervisor about the situation?
Yes, I do believe the nursing supervisor was contacted regarding this serious situation....furthermore, the patient was dropped off during change of shift 0700 and follow up with the history down in ER proved futile...new people working the night shift (scant bedside reports given by days) and not really accountable to the case LOL...
Thanks for all the contributers to this thread ;+))
PS. since I was working with my Stepdown/Tele patients and it was difficult to follow all the details and OH did I ever want to go home after working three nights straight TKO. ie: totally knocked out...LOL
Last edit by CaLLaCoDe on Jan 21, '07