IV Infusion/ question

[stervets]

I recently picked up a PRN job at a local SNF and there is this new nurse who was given a bottom management position who is going after everyone for basically nothing. Long story short, the her most recent obsession is IV ABT infusions. She writes up everybody who leaves tubing full of liquid (the bag is empty but there is some solution left in the tubing and a little in the chamber). I have worked in multiple hospitals and other SNFs and have never seen anything that ridiculous. Usually pharmacy slightly overfills their infusion bags taking this into consideration. Most ABT are therapeutic based on their levels and I am yet to see a low level caused by leaving 3ml of mixture in the tubing. I mean if a bag is a 250ml bag, 3-5ml is 1/50 of the total amount and seems so insignificant that it would be highly unlikely to affect therapeutic levels. What do you think?

[VANurse2010]

I've never seen it written as ABT. Only abx.

You've missed out, grasshopper.

[workinmomRN2012, BSN]

Bingo!! We have a winner.....ABT is antibiotic, I learned ABT although I have seen it ABX too:yes:

[PMFB-RN, RN]

Uh oh. You have a petty tyrant out to climb the ladder on the worker's backs. My advice is to stay far, far away from her but keep tabs on her. In a few years she will be DON some place and you want to make sure you don't go to work there.

Look it doesn't make the slightest difference if leaving some fluid in the tubing is right or wrong. I can't tell from the info you provided. It's either the case that she is incompetent and wrong, or (more likely) in your case it is incorrect way to do it BUT the proper management response is education and coaching.

By writing the nurses up she had made it perfectly CLEAR that she doesn't give a darn about improving things and just cares about making herself look good.

I hate these kinds of "people" (not the word I wanted) and try hard not to work for them. I also suggest keeping your eye on her to make sure every little mistake she makes gets brought to the attention of higher management. Give her a dose of her own medicine.

[ktwlpn, LPN]

Ask staff dev to speak with her,she may have little to no experience with IV ABT ,she may only need some education..

[iluvivt, BSN, RN]

lower volume antibiotics and other IV meds can often be given by syringe pump to eliminate this problem as I stated. Yes, you can hang a small flush bag of NS after the abx if you are setting it up as a primary intermittent using a locked VAD. We do not hang a flush bag after a primary intermittent at the the very large hospital I work at. We have a very low priming volume as the tubing is very short. Check you priming volume to see it is worth it. In home care I will hang a 50 ml NS flush bag on many of my specialty very expensive disease specific medications that are often a one time dose one a month or once a week so the patient gets every last drop. There are a few IV medications that are only compatible with D5W. The nurse is still a trouble maker!

[imintrouble, BSN, RN]

Control freak.

If you can hang on, she'll eventually burn herself out.

Not being able to control everything at all times, has a way of messing with your head.