she tried to access mediport, it was really a pacer - page 4

by jilliebean 9,771 Views | 42 Comments

nurse at work told me this horror story today,( she works per diem at another facility), was working this weekend in acute care, was called off the floor to try to access a mediport, after this other nurse tried 3 times. on... Read More


  1. 0
    I personally know nothing about ports. We had a regular patient in the ED for some time who was very difficult to cannulate (to the point anaethetists were called and failed), she has a condition which requires regular meds IV. She eventually got a port and attended the ED the week after, every one of us turned around and said we didn't know enough about them to even try!

    Not knowing and admitting it is so much better than trying and messing the whole thing up. This goes with assumed ports (though I would never even assume something was a port if it wasn't documented and even if I knew, I wouldn't touch it anyhow!).

    That pt is now managed by oncology as an emergency pt, much safer for her and us.
  2. 0
    Ports are the best things in the world for long term Iv therapy. I love them, the pts love them. Heck...I want one if the time ever arises when I need constant IVs or blood draws.
    The fact remains....if you dont' know what to do....don't do it. Stop. Ask. That is my biggest pet peeve.
  3. 0
    Quote from CRNASOMEDAY25
    I've heard of worse too. My charge nurse told me about an RN who ran a whole bag of tube feeding into a man's superpubic catheter!

    I'm just a student and I know better than that.
    There are many stories regarding wrong tubes being accessed:
    http://www.nso.com/case/cases_area_i...&area=Hospital
    http://www.nso.com/case/cases_area_i...rea=Pediatrics

    There are also many stories of po liquid/elixir medications being administered IV with horrendous results, I remember being told about dilantin elixir being administered IV. Another case involved an RN being pulled to an ICU environment, an environment she lacked expertise in, and a patient dying from KCL being given IVP.

    I precepted an experienced RN who kept wanting to draw coags from a peripheral site, the same site that heparin was infusing into and I could not get her to understand 3 things:
    #1. It is against policy at our facility to draw labs from an established PIV on a GPU.
    #2. You will receive inaccurrate results if you do draw your coags from the same peripheral site that you have heparin infusing into.
    #3. The patient had a PICC line on the opposite arm from which coags could have been drawn.
    Despite discussing these three points with her, I twice interecepted her from attempting to this and twice more discussed these points with her. There were numerous problems with this person not just this instance, the biggest problem was the lack of reception to information (she didn't want to listen and learn). BTW this person did not complete orientation. It's not just newbies with lack of experience that may have a problem, heck, in general they're more likely to ask questions.
    Exactly. Everyone makes mistakes that seem really horrible, incompetent, and negligent from the outside in. But if this was a case of an inexperienced person, they could have been set up to fail by the hospital from the get-go, with the way nurses are pushed off orientation before they feel ready and without proper training, and the way so many nurses eat their young and punish people who ask "stupid" questions.

    That is an excellent point.Hospitals want new grads...they are cheaper and unfortunately...inexperienced. With few experienced nurses left to properly orientate them....they are set up for failure.It is a loose -loose situation
    Yes there are meanies, new and old and inbetween. It's not always "nurses eating their young" (wish this saying would disappear BTW), more often than not it involves an environment that is not conducive for the experienced staff to be the support and resource they need when they come off orientation. It is definately a lose-lose situation.
  4. 0
    Quote from jilliebean
    nurse at work told me this horror story today,( she works per diem at another facility), was working this weekend in acute care, was called off the floor to try to access a mediport, after this other nurse tried 3 times. on arrival, she finds it wasn't a mediport at all, but a pacemaker. this other nurse had poked it with the huber 3 times, the guy was bleeding all over, apparently in critical care now. this guy never even had a mediport. Can you believe tis incompetence??!!

    And who cant tell the difference between them just by looking and feeling. or even just simply asking the pt
  5. 0
    Quote from DusktilDawn
    It's not just newbies with lack of experience that may have a problem, heck, in general they're more likely to ask questions.
    You know, you are so right. Recent graduates will ask questions and that's a good thing. A lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. I'll admit, being a 10 year experienced nurse, when something comes up that maybe I should know about but don't.... it's kind of embarrassing but I would never risk a patient's well being for my pride.
  6. 0
    leahjet
    ana's mommy





    join date: jul 2003
    location: wayyy below the mason-dixon line
    posts: 255 re: she tried to access mediport, it was really a pacer

    --------------------------------------------------------------------------------

    quote:
    originally posted by dusktildawn
    it's not just newbies with lack of experience that may have a problem, heck, in general they're more likely to ask questions.


    you know, you are so right. recent graduates will ask questions and that's a good thing. a lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. i'll admit, being a 10 year experienced nurse, when something comes up that maybe i should know about but don't.... it's kind of embarrassing but i would never risk a patient's well being for my pride.

    i dont know about this. i know that new grads will ask lots and lots of questions during their orientation....but afterward....a huge huge fear of theirs that i have heard over and over again is that their coworkers will think they are "incompetent"/stupid....and so after orientation they "watch" alot but ask few questions.i am speaking from experience - i was involved with a research study that investigated "why" so many new grads left teaching hospitals in their first year of employment. this is what they said over and over....that they "feared" being perceived as incompetent ...or not being able to "handle" a situation if after orientation they routinely asked questions.
    older more experienced nurses....usually ask.....bc they have seen what happens when questions are not asked. every once in a blue moon you will have some blooming idiot who doesnt. inexperience....isnt an excuse.....and if this nurse was experienced...stupidity isnt an excuse either.it sounds like this patient had alot of medical issues ...and it wasnt his first rodeo at this hospital. therfore ....he'd have a h&p on file.you dont access a port unless you know its been routinely used and flushed....and it is in their h&p that they do actually have a port a cath.ditto on the pacer.....that info was somewhere in this guys h&p. if he was that sick ( nonresponsive)....you would know it was a pacer bc he would have cardiac monitoring. bp and leads...thats one of the first things you do.it wouldve showed a paced rhythmn.and that doesnt mean you have to have someone click the "paced" box on that ekg monitor...if you are caring for cardiac monitored patients ...you should be able to easily spot a paced rhythmn for youself.
    dont lose sight of what happened...when that patient entered those doors and was admitted....he / she deserved safe medical and nursing care. ive seen plenty of competent new grads that can easily reconize a paced rhythmn...and any expereinced nurse caring for this "sick" of a patient...shouldve been able to reconize it as well. now...we have placed that patient at further risk...bc....now he has to have the pacer replaced....in addition to all the other issues he has going on.
    Last edit by Keysnurse2008 on Jan 24, '06
  7. 0
    Pacer and Port can be in same location and can appear similar to the eye but Good Heavens when you feel it, you can feel the silicone septum vs hard surface! After 1 stick, the nurse should have known. Poor patient.
  8. 0
    Quote from jilliebean
    nurse at work told me this horror story today,( she works per diem at another facility), was working this weekend in acute care, was called off the floor to try to access a mediport, after this other nurse tried 3 times. on arrival, she finds it wasn't a mediport at all, but a pacemaker. this other nurse had poked it with the huber 3 times, the guy was bleeding all over, apparently in critical care now. this guy never even had a mediport. Can you believe tis incompetence??!!
    I hate it when that happens! Just kidding.... unbelievable
  9. 1
    Quote from tnnurse
    leahjet
    ana's mommy





    join date: jul 2003
    location: wayyy below the mason-dixon line
    posts: 255 re: she tried to access mediport, it was really a pacer

    --------------------------------------------------------------------------------

    quote:
    originally posted by dusktildawn
    it's not just newbies with lack of experience that may have a problem, heck, in general they're more likely to ask questions.


    you know, you are so right. recent graduates will ask questions and that's a good thing. a lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. i'll admit, being a 10 year experienced nurse, when something comes up that maybe i should know about but don't.... it's kind of embarrassing but i would never risk a patient's well being for my pride.

    i dont know about this. i know that new grads will ask lots and lots of questions during their orientation....but afterward....a huge huge fear of theirs that i have heard over and over again is that their coworkers will think they are "incompetent"/stupid....and so after orientation they "watch" alot but ask few questions.i am speaking from experience - i was involved with a research study that investigated "why" so many new grads left teaching hospitals in their first year of employment. this is what they said over and over....that they "feared" being perceived as incompetent ...or not being able to "handle" a situation if after orientation they routinely asked questions.
    older more experienced nurses....usually ask.....bc they have seen what happens when questions are not asked. every once in a blue moon you will have some blooming idiot who doesnt. inexperience....isnt an excuse.....and if this nurse was experienced...stupidity isnt an excuse either.it sounds like this patient had alot of medical issues ...and it wasnt his first rodeo at this hospital. therfore ....he'd have a h&p on file.you dont access a port unless you know its been routinely used and flushed....and it is in their h&p that they do actually have a port a cath.ditto on the pacer.....that info was somewhere in this guys h&p. if he was that sick ( nonresponsive)....you would know it was a pacer bc he would have cardiac monitoring. bp and leads...thats one of the first things you do.it wouldve showed a paced rhythmn.and that doesnt mean you have to have someone click the "paced" box on that ekg monitor...if you are caring for cardiac monitored patients ...you should be able to easily spot a paced rhythmn for youself.
    dont lose sight of what happened...when that patient entered those doors and was admitted....he / she deserved safe medical and nursing care. ive seen plenty of competent new grads that can easily reconize a paced rhythmn...and any expereinced nurse caring for this "sick" of a patient...shouldve been able to reconize it as well. now...we have placed that patient at further risk...bc....now he has to have the pacer replaced....in addition to all the other issues he has going on.
    tnnurse, i would love to see the full results of your study.

    i think the issue of being perceived incompetent/stupid because of asking questions isn't just a new grad issue. i also think the first year a person works as a new nurse is the most stressful for numerous reasons:
    1. they do have a fear that they are incompetent. the transition from being a student nurse to being functioning staff nurse can be a difficult process. you go from being taught nursing as it should be and are thrust into nursing as it really is. you'll encounter so many things/situations that you were not taught how to handle in school. i think the first year nurses are the ones that will question themselves the most about their competence and whether they are cut out to be nurses.
    2. the preconceived ideas and ideals we held about nursing we when we choose the profession. we all had our own reasons for choosing to enter the nursing profession and with those reasons we all had our own ideal of what a nurse was and what nursing was supposed to be. whatever that ideal was, how many of us can say that nursing has been just what we expected it would be. it can also be disillusioning. this "death of the ideal" is a loss we go through, most especially during the first year we are in the profession. it can also be a difficult process that some can't work through.
    3. the work environment itself. it's not usually/never set up for a new grad just off orientation. they do still need guidance and resources they can turn to. if an experienced nurse finds their work environment stressful/difficult/overwhelming, multiply that x10 for the newbie. it's often not set up well for both the experienced nurse and the new grad. for instance, i start my 12 hour shift with 3 new nurses just off orientation and 1 nurse that was agency. so now i have 3 new nurses who will seek me out as their resource (understandable) and an agency nurse that will also seek me out as their resource (also understandable) because he/she is unfamiliar/has limited familiarity with the unit. oh yes, let's not forget i'm also charge and have a full patient load (the same as everyone else) on top of this. in a situation like that, how receptive to questions/interruptions and how supportive can an experienced nurse be? oh yeah, and how much hair did i have left at the end of that shift?
    i don't doubt that in this scenario, there were questions the newbies didn't approach me with, in fact it's this type of environment that discourages them from asking questions. i also doubt they realized the impact on myself being charge on the unit with the 3 of them only because they lack the insight from my perspective. what i mean by that is, i can remember being in their shoes as once being a newbie and can empathize with that, because they are not yet on my side of the fence, it's not really possible for them to be empathic and insightful towards my position.

    new nurses may fear being perceived as stupid/incompetent for routinely asking questions, i'm not saying they don't, it's another factor that adds to the stress of being a new grad. they may also watch and learn. they've also spent the last 3-4 years asking questions and learning from the "questioning/research" perspective. from my experience they do ask a lot of questions, sometimes they may not even be aware of how many times they do ask questions. it also wouldn't surprise me that for every 1 question they do ask, there may be 10 questions they refrain from asking. i'm not saying this as a put down to new grads. i expect that they will ask questions because they are still learning and want to learn. oh and btw, there are things experienced nurses can learn from new grads if they are receptive enough.
    you know, you are so right. recent graduates will ask questions and that's a good thing. a lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. i'll admit, being a 10 year experienced nurse, when something comes up that maybe i should know about but don't.... it's kind of embarrassing but i would never risk a patient's well being for my pride.
    you know leahjet, i'm never embarassed when i ask questions. i don't see any reason to be. i will never know everything and i don't know everything. one thing i've always loved about nursing is that there is always something new to learn. i view my peers as a learning resource, as i hope they view me the same way.
    Mulan likes this.
  10. 0
    Now...we have placed that patient at further risk...bc....now he has to have the pacer replaced....in addition to all the other issues he has going on.





    Come again? Why does he need a pacer replacement? Unless she trashed the wires leading out of the pacer, which would actually be worse than damaging the body of the pacer itself, since the wires actually embed themselves in cardiac tissue. (A procedure which could potentially damage cardiac tissue as well as risk infection.) The pacer itself can be literally unplugged from functioning wires and replaced with a small incision. (Again, risk of infection.)

    I imagined that all this could set him up for quite an infection--which could travel to and affect his heart--but I'm having trouble seeing how a couple of needle pokes could damage a pacer to that extent.
    Last edit by Angie O'Plasty, RN on Jan 25, '06


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