I can't believe that I made such a stupid mistake and am kicking myself!!! - page 4
by RN Chaos
I had to give a new IV to my patient, but I couldn't get it, so I left. However I forgot to get the touniquet out from patient's arm, and I found it out 1 hour and 30 minutes later... He was a confused patient, so he couldn't... Read More
- 0Sep 18, '12 by RN ChaosHi iluvivt
Thank you very much for your good words. I have a question if you dont' mind. How many days did it take to develop compartment syndrome??? Was patient okay at the beginning and developed the syndrome later??? When I called my unit, it was about past 12 hours, and he had all good signs, such as a strong wrist pulse, able to squeeze his hand, positive capillary refill less than 3 seconds, and natural skin color when I checked the patient with intern and charge nurse.
Can they develop compartment syndrome far later days????? I'm so worried now...
- 2Sep 18, '12 by RN ChaosHello everone,
I'm just so grateful for everyone's warm advices, support, and help. I will do my best to be a better nurse and forgive myself. I'm still bit angry with myself and worry about my patient. I'm going back today and will check on him for sure.
Anyways, it is always great that there are such many compassionate nurses out there trying to help each other. I wish I could be such a nurse someday!!!
God bless all of you.
- 0Sep 18, '12 by TinabeanrnGod bless you too honey. It so honorable how you wear your heart on your sleeve and you are so humble. You dont always find that in this field. That patient is FINE . Dont you worry. Its a life lesson. Gotta do me a favor though, gotta be all done with beating yourself up over that one. It was an honest mistake, and I think we have all done it. I have done it and the PCT said, Um Tina, are you forgetting something? I felt bad for about 2 seconds. But I have been a nurse for a while and I have learned to forgive myself right away, lol. When I was a new nurse I could not sleep from constantly thinking of what I did or should have done or may have missed. I have learned the hard way that I am not perfect. But I do strive for perfection with the idea that I will make mistakes along the way. Guess that's why we are human . Take the advice and put it over their gown from now on. And when you precept, teach your orientee the same thing.
- 0Sep 19, '12 by struggling rnThanks for all the comments. i am a nurse who started working recently. when ever i do a mistake i feel so restless and worried. i donot sleep properly thinking that i may not be a good nurse or not suitable to nursing. i will go to work nextday with lack of confidence and my mind preoccupied with mistake i did. i keep thinking about that until i do a next mistake and feel terribly stressed. i feel so terrible even for something silly. but im determined to become an excellent nurse in my future. praying to God to make me strong.
- 0Sep 19, '12 by iluvivtNo worries on the compartment syndrome based upon what you have said..the ones I have seen related to IV mishaps have developed fairly rapidly. If they are large and worsening and symptomatic they are taken to surgery immediately for decompression. I have even seen some develop from trapped blood in the tissue after an IV start. The patient was very anticoagulated and even though the IV was in the vein it was still leaking at the insertion site or on the posterior vein wall had been punctured on insertion. I have seen several develop after massive IV infiltrates and these are usually from ACF sites. ACF sites can be very difficult to detect infiltrations on. I have seen one happen b/c they did not monitor the IV site under the surgical drape. That one was horrid and we had to get an MD in that measured the tissue pressure with a special tool. The key is to monitor carefully and report any changes in condition to the MD.
I recently saw a patient with rhabdoomyolysis of both arms and developed an immediate compartment syndrome that worsened within 24 hrs and had to be take to surgery for ulnar nerve decompression. Get them to surgery fast and most are just fine.
All is OK...you did what was right...I am still learning even after 30 years as a nurse and making changes in my practice to perform better...
- 3Sep 19, '12 by GrnTea"Thank you very much for your good words. I have a question if you dont' mind. How many days did it take to develop compartment syndrome??? Was patient okay at the beginning and developed the syndrome later??? When I called my unit, it was about past 12 hours, and he had all good signs, such as a strong wrist pulse, able to squeeze his hand, positive capillary refill less than 3 seconds, and natural skin color when I checked the patient with intern and charge nurse.Can they develop compartment syndrome far later days????? I'm so worried now..."
Let's review the cause and pathophysiology of compartment syndrome. This refers to a specific compartment, the muscle that is enclosed in a very tough membrane-- you've seen it if you've boned a chicken or cut up an uncooked roast for stew meat. In compartment syndrome the tissue inside that membrane swells up, making the pressure inside it skyrocket. This, in turn, prevents arterial blood flow from entering the space, and the muscle necroses. (The crush injury is what produces the myoglobinemia as the necrosed/damaged cells release their contents in to the bloodstream.) The swelling also impinges upon nerves in the area, resulting in paralysis related to ischemic nerve damage.
All of this is agonizingly painful and develops quickly. Cause is most often related to injury-- a crush injury that produces swelling, for example, but can also be from toxic substances or a primary ischemic event bad enough to cause rhabdomyolysis (lysis of the skeletal muscle cells). You can also see something a lot like it if there is swelling inside a cast, which acts like that tough membrane for purposes of preventing arterial flow and resulting in necrosis. To have so much swelling that the skin itself acted like the membrane or a cast would take an astonishingly huge infiltration...and certainly would not occur from leaving a venous tourniquet on for an hour and a half, or at all.
Diagnosing or ruling out suspected compartment syndrome is done by sticking a needle into the affected muscle and reading the pressure inside it with a little gadget. Every ER or ICU has one; before someone invented the gadget, we used to just set up a needle and a water manometer. Wish I'd invented that gadget.
Treatment is to open the compartment surgically and leave it open until the swelling goes down (and to pray for no necrosis). These people have, thus, long open incisions in their (usually) legs, gaping and open to the muscle itself. You want to take really good care of those to prevent infection.
So. Let's see what we have here with your patient. We have a period of decreased (but not completely occluded) venous drainage, no arterial occlusion, no ischemia, no compartment trauma or swelling, and no loss of function. No worries about compartment syndrome.Last edit by GrnTea on Sep 19, '12 : Reason: spelling, clarity
- 1May 31, '13 by feelingdumbOnce when I was in clinical as a student nurse during my last rotation on the ICU I was in a hurry giving a patient his insulin injection... my preceptor had drawn up the insulin and capped it super tight. When I tried to pull off the cap it was very difficult and when I finally successfully pulled it off it made my hand jerk back. I was in such a hurry trying to get things done that I didnt realize when it had jerked back the needle had barely touched my other gloved hand and poked me just before I injected it into the patient. when I was charting I took off my glove and saw a small poke on my finger. I literally had a panic attack. I told my nurse and asked what we needed to do. We informed the patient and infection control determined that nothing needed to be done after that, since they already had all my blood-work I literally was in a panic all day I felt horrible and so stupid. I cried myself to sleep that night. My nurse was very nice though and she reassured me that it was ok and very brave of me to own up to it because others would just brush it off and be too embarrassed. She said these are the types of mistakes we only make once... Despite her comforts I still feel horrible even though the patient was very understanding about it I feel so dumb. I will never let myself hurry that quickly again.