I am a month into my second semester of NS. At clinical this week my patients IV infiltrated (NS) at end of shift and I did not notice. I thought it looked off 2 hours prior and felt it (not cool, not blanched) and asked the pt if they had any pain ( no) but I didnt say anything to the RN and now I feel like a moron because 2 hours later it was cool to the touch and swollen. I feel so stupid for not just going with my gut. Also, the patient had to use the bedside commode 2x and the bedpan 4x and I was so careful to know where her line was and watch so it didnt tug, but I never thought to tatk to her about arm positioning (it was in the antecubital) and she probably flexed a bunch through position changes. I feel horrible for the patient. I just feel like I should have prevented it. We just learned about this so I feel I should know better. Also I feel like the RN is going to hate me and feel like I cant efficiently care for patients. Sorry I just need to vent because I feel awful right now
Feb 8, '17
Infiltration happens for any number of reasons. Some are preventable, some aren't. You assessed the area, determined it wasn't infiltrated at the time, and went on. In all likelihood, I would have done the same. Don't beat yourself up! It doesn't seem like something toxic was running through the line that could cause damage and now you know that when you have that gut feeling you should continue to reassess and say something. We all make mistakes, it's how you react to them and move on that matters.
Feb 9, '17
Hey! I know it's hard, but try to just take this one as a "lesson learned" and give yourself both forgiveness and permission to move on. I messed up once and even though the patient wasn't hurt I was beating myself up about it. My preceptor noticed and had a little talk with me. He said something that impacted me a lot, and it was along the lines of "The thing here is not that you messed up. Everyone will mess up at one point or another. You need to get used to that, and you need to accept that. The question, and what is really important right now, is your reaction to it. When someone acknowledges their mistake, when someone owns up to it, and when someone learns from it, then I'm okay with it. Because then the chances of it happening again is really low. Are you owning up to it? Yes. Are you acknowledging it? Yes. Are you learning from it? Yes. It's the people who won't acknowledge their mistake, or who try and make excuses or pass the blame, or who refuse to look at it as a learning experience and determine what they could've done differently, those are the people I worry about."
You owned up to the fact that you should've spoken up and told the nurse, and I'm willing to bet you won't do that again. You learned from it, and are moving on now with some extra tools under your belt as far as assessment and communication. The patient ultimately wasn't hurt, you learned some valuable lessons, now it's important to forgive yourself. *hugs*
Feb 9, '17
Hey, antecubital is just about the worst site for an IV, so it shouldn't have been a surprise to your RN that it went kablooey. But there is a positive aspect - skin & tissue in that area is very elastic, so an infiltration won't cause many unpleasant issues for the patient.
You're going to become much more comfortable with the "care & feeding" of IV access as time goes on. You'll be fine.
Feb 15, '17
Never have I been upset with a student for something they did or did not notice about a patient. You are there in a learning capacity. NS infiltrating isn't likely to cause any issues. We only intervene with a process called extravasation if the medication infusing is known to have a high risk of damage to tissue, like vanco. In my facility, we'd notify a physician if damage was apparent or potentially needing surgical intervention (look up dopamine infiltration images, for an idea of that).
So, no harm done. Give yourself credit for now knowing and being able to identify the early signs of issues with IV sites. In the future, you can be confident in your observations. Cut yourself some slack!
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