Got fired for changing fluid rate - page 8
I was on orientation on days and then got moved to nights which is what I was hired to do. It was my first night on orientation with a preceptor and I was not feeling the best, was very tired got an... Read More
May 10, '13 by TaitQuote from psu_213A patient should always be monitored for possible negative outcomes. It's our job.At my hospital, if a physician writes a liter of fluid to be a 'bolus', policy is that it is infused of 1 hour (regardless of unit/floor/etc.). If the physician believes the pt cannot handle a liter in an hour, they should order a specific rate rather than a bolus. Either way, this does not mean the nurse should not monitor the pt for signs of overload.
May 10, '13 by AOx1Quote from SionainnRNThis is no longer recommended as most RCTs haven't shown benefit, and some show harm.Back to the OP did you try other things first like trendelenberg?
May 10, '13 by SummitRN, BSN, RN, EMT-BQuote from AOx1Thank you! This sacred cow was a good idea once, but we've known for well over a decade that Trendelenburg works in the first few minutes for the first few minutes following rapid hemmorage. After that intrinsic shunting/vasoconstriction render the central increase from trendellenburg near zero (unless medication or other pathology have inhibited these intrinsic compensatory measures).
This is no longer recommended as most RCTs haven't shown benefit, and some show harm.
Reserve trendelenburg for when you need central venous distention for a central line start.
Quote from TaitWhich indeed was the exact point I was making in the last sentence of my post....A patient should always be monitored for possible negative outcomes. It's our job.Last edit by psu_213 on May 10, '13
Quote from SionainnRNMy response was to both your post and to a post which read:Little confused as to what you're getting at. The pt in this scenario had a bolus ordered in the ED then 100 mL/hr on the floor, so the doc was specific. And since this pt was hypotensive she was not at risk of fluid overload...where is that coming from?
"So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity."
I was not trying to imply the physician did not order a rate of the fluids. My only point was, there is a protocol (where I work anyway) for a bolus rate.Last edit by psu_213 on May 10, '13 : Reason: I have no idea why my spacing won't post correctly
Quote from SionainnRNUnfortunately, that is not always true. I have seen CHF pt with low BP that will still be rehydrated gently and not have a liter just bolused into them. I've even seen boluses as low as 250 mL for CHF patients...especially those with poor renal function.And since this pt was hypotensive she was not at risk of fluid overload...where is that coming from?
May 10, '13 by NRSKarenRN, BSN, RN ModeratorThanks for all the advice offered to our member.
Acknowledging mistake, understanding how it happened and coming up with action plan to prevent re-occurrence will go a long way for next .
Consider RN refresher course if in a tight job market area to show you've taken extra effort to update skills.