Worried...did not clamp main IV line.

  1. Hi there, ok I'm pretty worried about this so here goes.... my patient was on a dilaudid pca, and I realized after my shift the other day that when I changed out the syringe i did not clamp the iv line. thus i'm afraid i may have bolus dosed my patient when i put the new syringe in.... i changed the syringe about an hour and half before i left for the night, and basically i'm just worried something may have happened. what if i did bolus them? the patient was sleeping, but arousable when i left, vitals stable. but i'm still worried. i will always be more careful in the future. just looking for a little reassurance. thanks.
  2. 13 Comments

  3. by   steelcityrn
    Will the PCA allow a bolus ? My feelings are the medication probably was trapped in the line, only to be given as the pump is set.
  4. by   chancie
    Our PCA pumps do allow programed bolus doses and loading doses. But I'm just worried that the action of screwing the new syringe into the line, and replacing it into the actual pump may have caused some of the medication to flow into the line and then into the patient. does that make any sense?
  5. by   steelcityrn
    I can only see a problem if the pca pump was opened and the tubing disturbed.
  6. by   chancie
    hmmm, ok. i mean, i did have to open the actual pca pump to replace the syringe. basically, i opened the pump with the key, unscrewed the old syringe from the tubing, screwed in the new syringe into the iv tubing, and then replaced the new syringe in the pump (made sure it was in the correct position, continued my settings, closed door, locked pump, etc). but i failed to clamp my iv tubing. i made sure not to press down on the syringe, but i'm nervous some make have been infused to the patient with this process anyway. so in that sense, yes the pca pump was opening and the tubing was handled to replace the syringe.....ahhhh! i appreciate your feedback!
  7. by   Esme12
    SOme PCA pumps have a built in saftey device that you actually have to unclamp the tubing once it is removed from the pump to bolus the patient. The patient would have already shown a problem as IV drugs take immediate effect. YOu need to take immediate corrective action and remember to always clam your tubing. Becomming lax in procedure leads to mistakes and harm. You should talk with your manager in private about your fears and get to know the pump better. It would be difficult to write an incident report as you aren't sure an incident occured. Learn your policy on PCA pumps....make a cheat sheet ifyou have too..........Please Be Careful!!! xo

    To err is human........to learn from it....DEVINE! (a little literary humor)
  8. by   canchaser
    It's a syringe right??? How does a syringe infuse without pressure to infuse? I dont see how forgetting to clamp the IV tubing might have caused incidental infusion.
  9. by   classicdame
    I believe there are safety features built in to the PCA pumps. I so wish everyone was beyond making mistakes---but then who would be MY nurse? Afraid there would be few nurses left
  10. by   chancie
    Thanks for the responses everyone. I am a pretty new RN, started in the ICU, and still getting the hang of things. I am also a HUGE worrier . This was not a matter of becoming lax in practice, just learning the ropes still. However, I will also remember to clamp my lines. And yes, it was a syringe being loaded into the pump, and since I did not press down on the syringe I'm hoping none of the medication went into the line when it was changed. However, I can see how some pressure could have been applied when the syringe was changed. So yeah, I just got nervous about it. As I said, patient was stable when I left.

    I appreciate the reassurance. I like to think that all my worrying helps me stay more aware and on top of things. I don't ever want to get too comfortable in my practice, esp in an ICU. So thank you everyone.
  11. by   CRNI(R)
    When in doubt about anything "mechanical" possibly harming your patient...look to your patient for the answer. I worked with a nurse anesthetist who caused a patient permanent brain damage because she was looking at her monitors and not at the patient. The monitors were not showing that the patient was suffering hypoxia and she failed to catch it before the damage was done.

    Sounds like your patient was stable and not overly sedated when you left with plenty of time for them to have shown you otherwise.
  12. by   AnnieOaklyRN
    most IV tubing has a built in fi.ter to prevent backpriming if that is what you mean. I wouldnt worry about it.
  13. by   EDrunnerRN
    Never worked the PCA pumps as I am an ER nurse but how much could you have really gave him just by adding a little pressure 2 mg? Its an IV medication so you would have seen pretty immediate changes in VS if you really gave him a big bolus. Now ya got me interested in how these things work...might take a trip to the ICU tomorrow...
  14. by   CCL RN
    Don't worry. You would have to push down on the syringe to give any kind of bolus. Do you not have a second RN do syringe changes with you?

    Although this was an isolated event (hopefully), just get into the habit of always clamping lines when you are changing syringes, pumps, etc. For regular tubing, You don't want to change an insulin gtt, or levophed gtt over to another pump and accidentally bolus that.

    And for all who say there is a built in latch to prevent accidental boluses, at least on regular alaris tubing, I have seen that fail. (I do realize we are talking about PCAs here, but I wanted to emphasize that we can't always rely in back up measures..)

    So, especially in the ICU, get used to clamping...