Stressed

[krenee]

I have recently started working in a level 3 NICU after about a year & a half in a level 2. I've made a few mistakes lately . . . Not med errors but not catching things I should have. For example last night my IV infiltrated, it was TPN & I'm very concerned about tissue damage. It was a new IV & the pump wasn't alarming resistance. Anyway I'm just feeling today like this is so much responsibility & maybe I'm just not up to it. Anyone else feel this way & get past it? There really was never anything else I wanted to do but NICU & I feel so lucky to be able to, but I don't want to be the cause of harm for these little ones :-(.

[labordude, BSN, RN]

First things first...take a breath. EVERY nurse misses something, especially in the beginning. As for IVs, make sure you look at the actual site and don't pay as much attention to the pump pressure limits. Use your own judgment and "when in doubt, ask someone else or take it out." There is a great deal of responsibility with being a nurse, but it can be magnified when dealing with tiny patients. If you are feeling uncomfortable about certain areas of practice, have you identified a resource that you are comfortable talking to? To be a better nurse, you have to admit when you don't know things and when you feel out of your element. You have already started by stating that, now you just have to work with your supervisor/manager/educator to deal with it. Best of luck!

[iluvivt, BSN, RN]

It is a common misconception that a downstream alarm is is an infiltration detector and it is NOT! Infiltration rarely sets off an alarm. So I agree with nicuguy.You need to use your assessment parameters to determine if an infiltration or extravasation is occurring. This should include assessing the site for coolness,blanching,tenderness,compare to opposite side (always do this it really helps)on preemies and infants you can also palpate for any induration, baby may be fussy,always know the date of insertion,expect irritating medications and fluids to decrease dwell time,check frequently.

[krenee]

Thank you. I will certainly be more careful. I called to check on the baby last night & the arm is ok. I am also having trouble leaving work at work! I worry about the babies, I worry about what I might have forgotten. It doesn't help that I'm working two jobs. So few days off to recover.