Emergency RN, BSN, RN, EMT-B 5,958 Views
Joined May 24, '06.
Posts: 570 (65% Liked)
I find it stunningly ironic, that a nurse who makes a living undermining the livelihood efforts of other nurses, is here asking for advice in how to obtain more of such employment. If you want to be a nursing mercenary, that's certainly your choice and right; but I for one would never assist you (or those of your ilk) in such efforts. You're not the only nurse who needs to eat; IMHO, your employment strategy of stabbing your colleagues in the back is akin to cannibalism.
My question is, can a PICC line catheter tip being in the right atrium cause ECG changes?
Maybe, but generally, it would be limited to rhythm abnormalities secondary to tissue irritation rather than ischemia (ST segment) infarction (troponin) events. If having a line in the RA or RV were that clinically dangerous, then it would negate the use of Pulmonary Artery (Swan-Ganz) catheters. PICC lines can also be used as a poor man's CVP line. That said, there is nominally a danger of perforation (tamponade) events but those are generally historically statistically small in view of the numerous central venous lines that have been inserted. Further, pacing wire tips routinely are placed directly into either the RA or RV, and if untoward events related to line presence were a big risk, that process would not be even possible.
My two cents? It was good that the nurses were astute enough to have caught the missed pull back, but in the final analysis, it was probably clinically insignificant.
Several years ago, I remember once wandering to the web page of New York State's Education Department License Division (they're the ones who grants and disciplines all NYS professional licenses) and looking up the revocation and suspensions of nurses; the results were eye opening. The majority, and I mean like 99 out of 100, of cause for license action was related to improper activity with controlled substances (theft, diversion, substitution, etc). Very, very rarely, did I see anything related to improper clinical care. Further, I was not able to find a single example of action taken for abandonment.
To make a long story short:
ED = confusion, down and dirty, stabilize and get 'em up alive, move on to the next victim.
ICU = figure out what's REALLY going on, fine tune, start the road to recovery
MED-SURG = heal, educate, rehabilitate, release.
It's a nursing continuum and one needs to remember that. After 30 years of hospital service in both Emergency and Intensive Care arenas, I won't belabor the point. But IMHO, I think that all ICU nurses should have an annual mandatory rotation in the ED and vice versa. The lack of appreciation for the clinical needs and differences of each setting is what drives this perpetual misunderstanding and my personal belief is that management seriously needs to look into providing a solution. However, one final note. If the confusion in the ED rises to the point that patient contacts are so haphazard that it OVERLY impacts patient care, then staffing is generally at issue.
the problem you're facing here is one of degrees. sure it is bad, but not as bad as hanging blood with d5 alone. will you get cell hemolysis? yes, but not to the degree that you would had there been no saline at all. that said, the amount of actually hemolyzed blood was probably small. here's why; generally, when blood is running, the regular ivf ns that runs with it is shut off. so, the blood likely only came in contact with the hypotonic solution at the very beginning and very end of the infusion. that is, the bulk of the unit was probably not affected by the mistake. also, any clots that may have formed in the line were probably trapped by the in line filter where the blood first came into contact with the wrong solution.
but make no mistake about it, this was a huge mistake.
there are times when you need to do what i call "personal time outs" to ensure that what you're doing is correct. just like when you get into a car, the first thing you check is make sure you have your seat belt on, adjust your mirrors, seat, and windows... all before you start the car. at least, that's the way it is with me. after a period, it becomes second nature to the point that you won't even think about it, you just do it. for transfusions, besides checking for the order, consent, and the five rights on the patient, you need to also check the entire iv, from infusion site back up to the bag before you even start to check the blood.
i'm sure that we don't need to berate you on this, as you're probably already pounding your head into a wall over this already. but, like they say, painful lessons are sometimes the best teachers. just be thankful that the patient didn't suffer any long term harm from it.
dextrose is sugar. sugar is what we put in water to make syrup. dextrose can cause fatal reactions when hung with blood.
you know, i could go the blah, blah, blah about the five rights that they drummed into us from nursing day 1, and wag my finger that you should be more careful and let this be a lesson, ad infinitum et nauseam; but i won't. why?
because frankly, there is nothing wrong with you; the fault is with the system. if drug manufacturers continue to name things that sound so much alike, then even seasoned rns with 14 years experience will continue to make the same mistakes. in the interest of patient safety, the manufacturer should be required by law to change the name.
btw, the clonidine (catapres - an antihypertensive) vs klonopin (clonazepam - a benzodiazepine used in seizure or panic disorder) mistake is probably one of the most notorious error prone pairs within health care. it's been zinging nurses and doctors for years.
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