IV safety

I would appreciate comment on the following: Last evening I ran afoul of my supervisor when I advised that a patient with an IV of D5 1/2 and NS with 20 meq of kcl was in need of a new site. The rate ordered was 75 ml/hr. With the nut wide open, only half the amount was being delivered even when the arm was in an ideal position. When she raised her arm, even slightly, the drip stopped altogether.

The patient was receiving the second of three 1,000 ml bags ordered. Not only would she not achieve the prescribed amount, I reasoned that if the catheter was resting against a vein or was blocked by a small clot, repositioning could release the blockade and potentially cause a sudden increase in the volume delivered. If this occured while unatttended, she could recieve too much fluid and kcl in a short period of time. This happened on the 3-11 shift and the nurse due on 11-7 was an LPN who would be responsible for my unit and another; more that 70 beds!

The supervisor reasoned that since there was no evidence of extravasion in the tissues and that she suspected the MD would dc the IV in the AM, it was of no importance. She forbade me to intervene and said I need not attend it further as there was an LPN on that sector and she was "qualified" to intervene.

This poses not only ethical but legal questions, especially since there was a drug in the solution. Incidentally, at the end of the shift only about 50% of the solution due was actually delivered. Thanks for listening.
MB RN

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