If it's infiltrated, restart it or at least try to

cwazycwissyRN, RN · Feb 5, 2003

I agree with meoynsmile......not to mention the dehydration of the patient. How long had the IV been left unattended?

ShandyLynnRN, BSN, RN · Feb 5, 2003

that's just crazy! I think we all have tried and then had to ask someone else to start one, or had a patient that we knew was a really hard stick, and asked someone more proficient in those to start one for us. But to just not do it at all? And what was her rationale behind that large of a flush? Just crazy!

deespoohbear · Feb 5, 2003

I agree with the other posters....this needs attended to.....what if the patient has complications from the infiltrated IV? Sounds like major problems just waiting to happen....

DIPLOMATICRN4HIRE, MSN, RN · Feb 5, 2003

Does that nurse not have a clue as to what an infiltrate looks like, I wonder if she knows how it feels. It hurts like He((.

I would write her up big time, and I would also let the HN know that she repeatedly doesnt do IV basic care which is clear she hasnt done. Did she think that because the patient had dehydration that the 125 cc of NS would magically go into the system via osmosis? What an idiot... unecessary pain and possible harm caused to patient.She is by no means looking out for the best interest of the patient. I bet she is one of those nurses everyone hates to follow on the next shift because they know they will have to restart every IV on all the patients. Sad excuse for a nurse.

Zoe

Burnt Out, ASN, RN · Feb 5, 2003

.....GEEZ-125 cc FLUSH:eek: ....That is darn close to a bolus!!!!!

This needs to be addressed-ASAP!!!

Poor patient...I bet he/she thought their arm was going to explode!!!! :uhoh3:

You know, If I came in behind a nurse that let a patient go without an IV WITH A DX. OF DEHYDRATION for 8 or 12 hours....I would be:( :devil: !!!!!!!!!!!!

RNforLongTime · Feb 5, 2003

I'm confused night owl,

Was this her pt or yours? In your post you say it is your pt. So if that is the case then wouldn't it be your responsibility to restart the IV if you have no IV team? Or was your co-worker the treatment nurse whose responsibility it is to restart IV"s? IF the latter is the case then she should definitely be written up, You can usually tell an infiltrate by sight for sure and only 3-5cc NSS flush. But 125cc? Hello!

kmchugh · Feb 5, 2003

This goes beyond gross negligence. This goes beyond malpractice. This is nearly a criminal act, not only worth being written up, but also needs to be reported to the State Board of Nursing.

The arm was already edematous, and she added a large volume of fluid to the tissue. I have seen patients develop compartment syndrome from infiltrated IV's, bad enough to need surgical intervention (fasciotomy). A 125 cc bolus to an already edematous arm put the patient at severe risk. On top of that, she denied a dehydrated patient needed fluids owing to her reluctance to start an IV.

The nurse must be reported to your nurse manager. Her lack of knowledge, her lack of compassion, and her lack of common sense all combine to make her a severe risk to patients.

Kevin McHugh

montroyal · Feb 5, 2003

Originally posted by kmchugh
This goes beyond gross negligence. This goes beyond malpractice. This is nearly a criminal act, not only worth being written up, but also needs to be reported to the State Board of Nursing.

Kevin McHugh

Couldn't have said it better.

Darlene K. · Feb 5, 2003

This would be a write up in my book! That is just poor nursing. No excuse.

Home Health Columnist / Guide · Feb 5, 2003

In PA, LPN's are not permitted to start IV's without having attended an IV course and then can only administer few IV solutions.

Write up the facts objectively on incident report:

1. On rounds observed patient XYZ's iv site (give location) to be swollen (give size of swelling: 25 cent size, 50 cent size etc.) . I stoped IV infusion and notified RN A.

2. RN A examined patients IV site.

3. Upon return to patient, arm swelling observed (state size/amount ---1/4 up right arm) .

4. Renotified RN A who stated to me she gave 125cc bolus to see what would happen. (write in exact words if mentioned)

5. Write what you and she did next.

6. IV was left till next shift....

In seperate note, I would explain you are documenting this occurance as you have noted it to be a pattern that when you work with Nurse A , your patients problem IV site are often left fot the next shift to change, etc.

Was doctor notified about this at all. YOU have the legal authority to do that even if it is expected by your facility that RN makes calls (since LPN's in PA not allowed to accept routine orders).

Write this up and keep copy for yourself. This is a lawsuit situation waiting to happen.

A good facility after seeing this SHOULD counsel RN, require her to have refresher IV inservice and supervision of IV insertions/IV management. If this does not occur, I would report situation to State Board of Nursing before serious injury to patient occurs.

ERNurse752, RN · Feb 5, 2003

I second what kmchugh and NRSKarenRN said...

FullMoonMadness · Feb 5, 2003

Had an infiltrated iv just last night. Found it on my initial round,stopped it and told pt I would be back.The nurse that I followed told me in report that"this pt is a pain in a--. Her family complained about me to admin". Well,the pt stated her arm had been swelling all day,and when I charted my assessment,the previous nurse indicated in her assessment that "arm swollen and tender to touch" yet did nothing to remedy the situation.This is also a pattern with her. Poor pt,the IV had Kcl added to the ns. Fixed the sight,gave her a compress and wrote it as an incident report.I don't like to appear punitive but this is just not right