My biggest mistake, EVER

Specialties Operating Room

Published

Specializes in Only the O.R. and proud of it!.

Just the other day I took over operating the cell saver from another employee. After running my final bowl of RBC's, I was just sitting there, monitoring the blood loss, when I suddenly noticed that I washed the previous bowl with LR rather than NaCl! It had been 15 or 20 minutes since infusing the blood. I literally got nauseated and my heart rate must have climbed to 120! I immediately informed the CRNA. She reasuured me that no harm would come to the patient.

Boy, do I feel stoooopid!

I have never made such a serious error.

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And having done this, you will be ever so much more careful in the future. Thank goodness that it did not harm the patient.

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It takes alot of courage to admit an error and even more courage to share it. Good for you!

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Specializes in Only the O.R. and proud of it!.

Thanks, passionate!! I apprecite the words...

Apparently, my error should only change the oxygen-carrying capacity of the RBC's in that last re-infused unit (at worst). At best, nothing. As LR is routinely used IV (as we all know), that is OK!!

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My biggest mistake? Dropped the skull flap. That night I learned bone can be autoclaved. So, I guess it wasn't my worst mistake ever. That is probably yet to come.

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