she tried to access mediport, it was really a pacer

Nurses General Nursing

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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??!!

Specializes in Utilization Management.
But a pacer is much larger than a portacath, where a pacer is likely to be square, the portacath is circular and about the size of a quarter at best. Not knowing if the patient has a pacer or a port, it is always better to insert a peripheral than accessing anything. The worst thing that can happen is that you stuck the patient unecessarily, but it's not as risky as what this nurse did. You can always remove the peripheral and access the port once verified. My first impulse if I see something like that would be to assume that it's a pacer, then dig in the charts for more info. Or ask the family if they're present.

Well mine's round and not much bigger than a quarter. It does feel like a port, except the top is not soft. Pacer shapes vary too.

pacemaker.jpg

She knew enough to use a huber needle. I say gross incompetence.

Wow that's scarey. I've accessed so many mediports in the ED. It's not just oncology patients who have them. And no, we don't need a doc's order to do it. But I always knew whether or not they had one.

It still isn't clear whether the patient was aware or not.

Specializes in Geriatrics, Cardiac, ICU.

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.

All's I know was the guy was "pretty out of it." she said he had a high ammonia level, and needed iv fluids (sounds like he might have been a new admit, to me) that's about all I know.

I beleive it and could see it happen in my LTC unit.

Note to self...remind some to make sure they know what a pacer is and what a port is.

Isn't the first step in accessing a port is to assess the port. Feel it. Know what and where you need to hit?

If you aren't sure and not comfortable doing a procedure ask or look it up. There is no stupid questions!

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.

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.

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_index.php?id=111&area=Hospital

http://www.nso.com/case/cases_area_index.php?id=43&area=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.

Specializes in ER, ICU, L&D, OR.
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

Specializes in ICU,ER.
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.

leahjet

ana's mommy

join date: jul 2003

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posts: 255 re: she tried to access mediport, it was really a pacer

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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. :nono:

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