Some nurses make you sick!!! - page 2

hello everyone!! so here is my vent!!!:angryfire, i work at this lovely ltc , anyway i just got off working 11-7 shift, the supervisor calls me as i am goin home and tells me that the day nurse... Read More

  1. by   Nrs_angie
    Hi there,

    [FONT="Comic Sans MS"]Since most of my experience has been with Vascular and Plastic Surgery patients... I could be wrong about this. But my first instinct would tell me that if the bottle was up for 24 hours it should have been tossed, regardless of what was remaining. I definately know that enteral tubing is tossed in 24 hours... so shouldnt the bag be tossed as well?? Again, ive only seen a handful of tube feedings and I was dayshift or second shift. We mostly started the tube feeds on night shift. My second instict tells me that if the order was for 600 ml every 12 hours, then I assume it was running at 50 ml/hr which is a very common rate... usually they run 15 to start, and work up to as fast as 80, depending on how it is tolerated ect. If these assumptions are correct, then the 400 ml would have lasted until 10 am. Your shift would have been over by 7 am. So I really don't understand why she called to report you??? Am I missing something here??? If someone out there sees something that I am not getting, please correct me...

    In future, I think the best thing is to let the oncoming nurse know that the feed is still running and always tell her how much is up (remaining amount) the last time you checked it. This way she knows when to plan to hang a new bag/bottle. Offer to check it before you go... she may just say, "thats ok, I'll check it, go home and get some sleep!". Atleast this way she is aware of it.
  2. by   EmmaG
    Quote from Kanani_Ikike
    I think that since this was the first time a mistake was made, the other nurse should have confronted this nurse instead of going to the supervisor on her. And the supervisor should have stepped up and explained to the other nurse that this is a new nurse and that she needed to be counseled.
    True, but:

    I'm not making any excuses by I dont think it was right for the day nurse to report me, even if she told the supervisor to just remind me to be more careful, or even if she spoke to me first directly!!
    To be honest, the OP wasn't very clear about what exactly the complaint was all about. And Lord knows, we all forget stuff, no matter what our experience, so I can understand her frustration. As far as the feeding, it's up to the nurse to know proper policy and procedure or know where to look it up, regardless of how new they are.
  3. by   EmmaG
    Quote from Nrs_angie
    Hi there,

    Since most of my experience has been with Vascular and Plastic Surgery patients... I could be wrong about this. But my first instinct would tell me that if the bottle was up for 24 hours it should have been tossed, regardless of what was remaining. I definately know that enteral tubing is tossed in 24 hours... so shouldnt the bag be tossed as well??
    Policy everywhere I've worked is that all feeding tubing, bags, etc., are tossed at 24 hours. Feeding that is in a sterile liter pre-filled container is good for 24 hours while infusing, but if disconnected and just hanging there? A new one must be set up, and especially if it is going to run past that 24 hour mark. And those where you add to the feed, never add more than can be infused over 4 hours.
  4. by   Nrs_angie
    Quote from Emmanuel Goldstein
    Policy everywhere I've worked is that all feeding tubing, bags, etc., are tossed at 24 hours. Feeding that is in a sterile liter pre-filled container is good for 24 hours while infusing, but if disconnected and just hanging there? A new one must be set up, and especially if it is going to run past that 24 hour mark. And those where you add to the feed, never add more than can be infused over 4 hours.
    Hello and thank you Ms. Goldstein,

    But what do you mean by those where you add to the feed? Can you clarify? Do you mean increase the rate? increase the dose?

    Thanks
  5. by   EmmaG
    Quote from Nrs_angie
    Hello and thank you Ms. Goldstein,

    But what do you mean by those where you add to the feed? Can you clarify? Do you mean increase the rate? increase the dose?

    Thanks
    I mean from cans that you add to a bottle or bag, rather than the pre-filled bottles you spike directly. (am I making sense lol)
  6. by   CoffeeRTC
    Lots of things wrong here, but does that really warrant a call to the employee? Couldn't all of this have been brought up the next day when she/ he worked? I think I would have waited and spoke to the nurse when she came on the next shift and reviewed the policy of tube feedings.

    I can't tell you how many times I came on a shift to an empty tube feed, a beeping pump etc. Yeah...it isn't very nice, but if it happens all the time, you bet I might say something.
  7. by   TeresaB930
    I agree. She doesn't state that she didn't do these assessments. Also, in LTC we have these 2000mL bottles of nourishment for our G-tubes. Thats exactly what I thought of when she said their was 400mL left. We use up the previous b4 spiking a new bottle.

    Let's give the poor girl a break.....I don't know how many times I've gone home and thought of all the things I should have done. We learn from our mistakes.

    Teresa
  8. by   Nrs_angie
    Quote from Emmanuel Goldstein
    I mean from cans that you add to a bottle or bag, rather than the pre-filled bottles you spike directly. (am I making sense lol)
    Gotchya now!

    hehe, duh I feel dumb...

    Actually though, I have never heard that you should not add more than will infuse in 4 hours... Why is that?
  9. by   RNroseshea
    Personally, if I came into the room and found 400ml in the bag I would have just thrown it away. Next, I would have just started my own new fresh feeding in a fresh bag. These feedings are to be changed every four hours to every shift at least. I frequently did feeding tube care as a student nurse. I am a new RN and I definately would do the same thing as I did a SN, with the addition of checking residual, placement, etc. If I was a patient, I would sure not want to lay in the bed with a peg tube feeding that is infusing bacteria, even if my bowel is not sterile.
  10. by   rosygirl
    I hope you will take this the way I mean it. This will not be the last time another nurse complains about you :uhoh21:. It is a fact of nursing life, for various reason, many that have less to do with you and more to do with other nurse, or the working situation, we pick at each other. Hang in there, learn from this and do your best.
  11. by   EmmaG
    Quote from Nrs_angie
    Gotchya now!

    hehe, duh I feel dumb...

    Actually though, I have never heard that you should not add more than will infuse in 4 hours... Why is that?
    I'm sorry... I know I'm not making much sense here lol. Our policies (and info from the companies we purchased from) stated the formulas were only 'good' at room temp for up to 4 hours. So we'd not put more in a bag or bottle than would infuse over 4 hours.
  12. by   morte
    the large, prefilled bottles actually have a 48 hour hang time....in LTC it is common practice to have feedings that are intermittent...therefore the bottle would be discontected and reconnected.....the tubing is changed with each bottle..

    however the 48 hours only applies if the spike is left in the bottle....there is a filter for air to get into the bottle....if air is allowed in thru pulling the spike, than it reverts to a 24 hour hang time
    when using the bags, you need to be careful...it is the coating left behind on the bag which is going to foster the growth of bacteria, so perhaps they shouldnt be refilled?...i have never heard/read about the four hour rule (dont doubt it applies, at least to some formulas) so i would fill the bag as full as possible, not wanting to "wash" the bacteria down into the formula..
    Last edit by morte on Nov 15, '07
  13. by   Insurance RN
    I also cannot get past the fact that the OP infused the 400 cc's that she found when she went to hang the new tube feeding.
    But, my bigger concern is that the OP stated the patient receives 600 cc's of tube feeding q 12 hours, that @ 2 AM when she went to hang the new tube feeding is when she discovered that not all of the previous feeding had infused. Why was this not discovered until 2 AM? I may not be seeing the whole picture here, but it appears that the evenng shift missed this as did the OP until 2 AM. Does the oncoming shift do pateint rounds with the previosu shift?

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