cannot get over mistake

Chad_KY_SRNA · May 5, 2005

It's hard to overcome some mistakes, you learn from them and become a better nurse.

mstigerlily · May 5, 2005

Your post really touched me, I think this is everyone's worst nightmare. Does your hospital have a program for nurses who have had something like this happen? Ours does and it is well used.

9 years is a long time to be depressed. Of course you can't forget something like this - nor would you want to. But you need to forgive yourself, learn from it and move on. Please continue with therapy, if it's not helping, find someone else to help you, don't give up until you are satisfied.

Melissa

i'll try to be as brief as possible but here goes - i have been a nurse for about 9 years - when i was new on orientation i was overwhelmed, rushed, panicked and made a mistake by not priming an iv line properly - the patient got a cerebral embolism and died a week later. since then i continued nursing but have never been able to get over this and have suffered extreme depression. i have never been able to forgive myself for being so stupid - i was a straight A student - the kindest person you could know - since then i have been to therapy - but nothing seemed to help. please try not to be too brutal with your replies.

PamUK · May 5, 2005

If you were in orientation, was there no-one checking everything you did?

You are not entirley to blame here. You were new, rushed, overwhelmed. Your supervisor is also responsible for not ensuring that you were adequately supported.

Read the link below. The way I undertand it is, that air entering the venoous system in the way you describe, do not cause cerebral embolisms

http://www.emedicine.com/EMERG/topic787.htm

After reading this article, for an adult weighing 65kg (143.3lbs) you would have to introduce at least 200ml of air into the venous system. What is the volume of IV tubing? 5ml? 10ml? The maths dont add up.

And neither does the clinical picture. Air embolisms cause "acute right ventricular outflow obstruction and result in cardiogenic shock and circulatory arrest. Intermediate amounts of air collect in the pulmonary circulation and produce a pulmonary vascular injury manifested by pre- and postcapillary pulmonary vasoconstriction, pulmonary hypertension, endothelial injury, and permeability pulmonary edema. "

Are you absolutely sure that you actions, and only your actions, caused a cerebral embolism? Scapegoat comes to my mind

Be kind to yourself & work this one out. Rationally

takrn · May 5, 2005

If you were in orientation, was there no-one checking everything you did?
You are not entirley to blame here. You were new, rushed, overwhelmed. Your supervisor is also responsible for not ensuring that you were adequately supported.
Read the link below. The way I undertand it is, that air entering the venoous system in the way you describe, do not cause cerebral embolisms
http://www.emedicine.com/EMERG/topic787.htm
After reading this article, for an adult weighing 65kg (143.3lbs) you would have to introduce at least 200ml of air into the venous system. What is the volume of IV tubing? 5ml? 10ml? The maths dont add up.
And neither does the clinical picture. Air embolisms cause "acute right ventricular outflow obstruction and result in cardiogenic shock and circulatory arrest. Intermediate amounts of air collect in the pulmonary circulation and produce a pulmonary vascular injury manifested by pre- and postcapillary pulmonary vasoconstriction, pulmonary hypertension, endothelial injury, and permeability pulmonary edema. "
Are you absolutely sure that you actions, and only your actions, caused a cerebral embolism? Scapegoat comes to my mind
Be kind to yourself & work this one out. Rationally

I was on orientation but basically told after 5 weeks i should be able to handle my 8 or 9 patient by myself and that i am too slow - the patient had a central line - so i really feel like it was my fault. the sad part is that nobody seemed to think it was a big deal at all - meanwhile i was devastated. although looking back i do think i should not have been left alone with 8 or p patients - somedays it was 12 patients for one nurse - i was completely in over my head which i still feel is no excuse - i'd also heard before that it takes a lot of air to cause a problem so i really didn't think i would cause harm. i guess i feel like i should have been punished and never was - since then i have been a good nurse - very cautious - and never let myself be rushed to the point of carelessness.

allnurses Guide · May 5, 2005

If you were in orientation, was there no-one checking everything you did?
You are not entirley to blame here. You were new, rushed, overwhelmed. Your supervisor is also responsible for not ensuring that you were adequately supported.
Read the link below. The way I undertand it is, that air entering the venoous system in the way you describe, do not cause cerebral embolisms
http://www.emedicine.com/EMERG/topic787.htm
After reading this article, for an adult weighing 65kg (143.3lbs) you would have to introduce at least 200ml of air into the venous system. What is the volume of IV tubing? 5ml? 10ml? The maths dont add up.
And neither does the clinical picture. Air embolisms cause "acute right ventricular outflow obstruction and result in cardiogenic shock and circulatory arrest. Intermediate amounts of air collect in the pulmonary circulation and produce a pulmonary vascular injury manifested by pre- and postcapillary pulmonary vasoconstriction, pulmonary hypertension, endothelial injury, and permeability pulmonary edema. "
Are you absolutely sure that you actions, and only your actions, caused a cerebral embolism? Scapegoat comes to my mind
Be kind to yourself & work this one out. Rationally

This is my understanding as well. Although we did have a teacher in clinical who said don't rely on the above stats. Just make sure you don't advance air in IV tubing.

I think you need to seek more counseling with someone knowledgable regarding medical practice. And I think you need to forgive yourself.

steph

UM Review RN, ASN, RN · May 5, 2005

After reading this article, for an adult weighing 65kg (143.3lbs) you would have to introduce at least 200ml of air into the venous system. What is the volume of IV tubing? 5ml? 10ml?

I just heard the same thing about air embolisms in a teaching on PICC lines.

I'm so sorry that your patient died, takrn, but I also doubt that your actions caused it. In nursing as in life, there really is such a thing as coincidence.

:icon_hug:

PamUK · May 5, 2005

I would go as far as saying your actions did not cause a cerebral embolism.

Was any action taken against you? Did anyone else know wht you had done and blamed you directly or do you just believe that you caused this patients death?

We all focus on little things "mistakes" events etc and they become exaggerated in our own minds. You are not to blame

PamUK · May 5, 2005

Oh, and go back to the anatomy & physiology. How can air introduced into a vein cause a cerebral embolism?

Please... forgive yourself for not doing your task properly. It was sloppy, but hey!! we are all sloppy at times. But dont blame youself for this patients death. The two issues are not related

NurseFirst · May 5, 2005

I was on orientation but basically told after 5 weeks i should be able to handle my 8 or 9 patient by myself and that i am too slow - the patient had a central line - so i really feel like it was my fault. the sad part is that nobody seemed to think it was a big deal at all - meanwhile i was devastated. although looking back i do think i should not have been left alone with 8 or p patients - somedays it was 12 patients for one nurse - i was completely in over my head which i still feel is no excuse - i'd also heard before that it takes a lot of air to cause a problem so i really didn't think i would cause harm. i guess i feel like i should have been punished and never was - since then i have been a good nurse - very cautious - and never let myself be rushed to the point of carelessness.

The difference between a person who is depressed and one who is not is the way they think. Here are some things to think about that may help you think differently...

Heads of state often send hundreds and thousands of young healthy men to their death. I've read that physicians, in learning their trade, usually make 2-3 fatal mistakes. Young men come back from war, having fulfilled their responsibility, having killed "the enemy."

You sound a bit perfectionistic to me, which may be underlying your depression. Your situation also might be a case of post-traumatic stress disorder; due to the miserable situation you were in, you have overblown what happened and your responsibility in it. I really don't know. The fact is, neither do you. But, based on what sounds like flimsy evidence, you have tried and convicted yourself to the prison of depression for 9 years. Hey, even a first degree murderer gets to be tried by a jury of their peers! No fair!!!

If you haven't tried cognitive therapy, try some of that. You could find a therapist that does EMD--that might be helpful. You might look for an NLP Master Practiitioner and use reframing and submodality work to help you out.

Your responsibility in life is to be the best you that you can be, as well as to realize that NO ONE is perfect. In some sort of perverse logic in the world, sometimes when we try to be perfect, we actually make more mistakes! I think it's God's way of making/keeping us humble. :) Very simply, you are abdicating your responsibility to be the best you that you can be by being depressed. Think about it. If it's helpful to you, keep the thought. If not, forget I said it.

Good luck to you!!! We need good, conscientious, caring nurses. It sounds like that's you. Please don't rob us of you! We need you!!!

Best Regards and Keep in Touch,

NurseFirst

estrogen · May 5, 2005

i'll try to be as brief as possible but here goes - i have been a nurse for about 9 years - when i was new on orientation i was overwhelmed, rushed, panicked and made a mistake by not priming an iv line properly - the patient got a cerebral embolism and died a week later. since then i continued nursing but have never been able to get over this and have suffered extreme depression. i have never been able to forgive myself for being so stupid - i was a straight A student - the kindest person you could know - since then i have been to therapy - but nothing seemed to help. please try not to be too brutal with your replies.

forgive me for asking, but I would really like to know what are the consequences for you and for the hospital when something like this happens? Was there a lawsuit? It yes, what was your role in it?

Please understand, I am absolutely not judging you. I am a fairly new nurse (2 yrs) and I am well aware that God forbid, something like this could happen any day to any of us... I am just wondering, what happens next, after something like this happens...

BandEmom · May 5, 2005

What happened to you could happen to anyone nervous and new.

You obviously have a big heart, and we need you around. It really does not sound like your actions were the cause of this pt's death.

I'll keep you in my prayers.