Mistake that cannot be done by nurse

[deepurple]

yesterday, i'd been made mistake. When i'm flush the neck line with hepsaline at pt who is a nearly 1 year old baby, there is bubble when i withdraw little bit blood to see whether the line is functioning well or not but i didn't see the bubble properly then i pushed t back. At that time one of senior staff supervise me and she didn't stop me but let me finished it after i'd flush that line. I'd been scolded by her and she said that bubble will be harm the patient. That patient is post cardiac surgery and i was very worried until now. i'd flushed that line because i want to give antibiotic through infusion. I want to know for the sake of patient that i'm very worry about that bubble, is it really really will harm the patient? In my opinion, supposed to be she stop me from injecting back the blood after i withdraw it a little bit but she let me finish it then she scold me.. In this situation, i admitted that it was my fault because i'm not see it properly. I'm very frustrated that i had done that. After this i will see it clearly the bubble and will not inject it into line, For future, when i'm supervise the junior, i will not stand back and just shut mouth when i see my junior staff done this. I will stop it for good both of us. I will.! I pray that this patient is in good condition today. Will you all pray for this patient. Thank you for lend your ear to hear my problem.TQ

[NotReady4PrimeTime, RN]

It's not exactly the same thing. It will work, because then you can aspirate the bubble into the syringe. As long as you keep everything at that 90 degree upward position the bubble with go to the plunger end of the syringe and therefore not be injected into the patient. I still hope to get the photos I talked about but it has been VERY busy on my unit this weekend and tomorrow will be worse still, so I may have to try something else to show you what I mean.

[NotReady4PrimeTime, RN]

I finally had time to make my little photo tutorial for you.

Starting point with cap on stopcock.

Cap removed.

Air in the dead space

.

Hold the syringe at a 90 degree angle to the port and drip flush into port.

If you drip slowly and smoothly there are no bubbles. Flick the stopcock if needed.

You should have a dome of fluid on the port like this.

When you attach the syringe to the port, the dome of fluid will "spill" and you'll have an air-free connection.

Bubble-free flushing.

This is how we ensure air-free connections on our ECMO circuits, where even a microscopic bubble could be catastrophic. Does this help?

[deepurple]

Thank you for sharing this knowledges with me....It is really helpful. The syringe also must be free of bubble to right? have you see some nurses connected the syringe first and syringe out ...to see whether there is bubble or not.If there is bubble come out, they will syringe out the bubble then they flush the line.

[NotReady4PrimeTime, RN]

Yes, that can also be done, but it won't work if you're unable to get blood back into the line. All you'll do is create a vacuum. If that's how you choose to clear any air from the dead space in your port, you MUST hold the syringe vertically so that the air will rise to the plunger end and away from the port. And you have to be absolutely sure you've flushed ALL of the blood out of the line so that there won't be a clot or a strand of fibrin forming at the tip that will occlude your lumen when you attempt to aspirate later.

[deepurple]

Thank you so much janfrn..you are really helping me....

What should i call you? May i know your name?

[deepurple]

dear janfrn

i had a problem when taking blood pressure with blood pressure machine.

i'm still new i pediatric ward. there must be some tips or technique in taking blood pressure for them. the most important thing is i want to know how to put the cuff blood pressure at the right position at the leg.

[NotReady4PrimeTime, RN]

I know you've read the reply that Ashley, PICU RN posted into the thread you started with this question. There's not much I can add.

[canned_bread]

That photo tutorial was fantastic! I never knew that, I always just did everything at 90 degrees letting gravity help me, and watched and flicked and fiddled...!

[NotReady4PrimeTime, RN]

That photo tutorial was fantastic! I never knew that, I always just did everything at 90 degrees letting gravity help me, and watched and flicked and fiddled...!

I'm happy that it helped.

[wooh, BSN, RN]

I finally had time to make my little photo tutorial for you.

Nice work!