what would you do

[UtErRnEmt]

just curious what the rest of you would do with this situation. i had a ca pt on chemo come in. was found to have a severe uti (possible urosepsis per the doc) as well as a low h&h. the pt has a single lumen port and no peripheral veins. normal hr and bp. came in due to weakness. i decided due to immune compromise to hang her iv abx before the blood as she had normal vs. i was told i was incompetent for doing that and fired (i was working as a travel nurse). would you all have done the same or not? thanks

[Tweety, BSN, RN]

Fired?????????

I would have done the same thing. Sepsis in a chemo patient can be deadly. Considering the patient was hemodynamically stable I would have hung the antibiodic because that can run in a lot faster and can be running while I get things ready and go to the blood bank and get the blood.

More than likely you could have hung the antibiodic while waiting for the type and cross to be done and the blood getting ready.

I'm thinking like a floor nurse. An ER nurse of course thinks like an ER nurse and perhaps thinks blood first, which is why the extreme reaction you got. But the telltale sign was that the patient was hemodynamically stable. First and foremost if the ABCs are o.k. then you go on to the next thing and prioritize.

Your firing was uncalled for in my opinion.

Good luck and good riddance to them.

[pkapple]

:yeahthat:

[NRSKarenRN, BSN, RN]

Fired?????????

I would have done the same thing. Sepsis in a chemo patient can be deadly. Considering the patient was hemodynamically stable I would have hung the antibiodic because that can run in a lot faster and can be running while I get things ready and go to the blood bank and get the blood.

More than likely you could have hung the antibiodic while waiting for the type and cross to be done and the blood getting ready.

I'm thinking like a floor nurse. An ER nurse of course thinks like an ER nurse and perhaps thinks blood first, which is why the extreme reaction you got. But the telltale sign was that the patient was hemodynamically stable. First and foremost if the ABCs are o.k. then you go on to the next thing and prioritize.

Your firing was uncalled for in my opinion.

Good luck and good riddance to them.

:yeahthat:

Hemodynamically stable...agree above 100%.

[TazziRN, RN]

I'm an ER nurse and I would have hung the abx first too. Both were probably ordered at the same time, and it takes much longer to get the blood from lab than the abx from pharmacy.

Have you talked with your agency about this? Or were they the ones who fired you?

[jojotoo, RN]

I'm also an ER RN, and I would have hung the abx first under the conditions that you describe. Sounds like there's more to this story - previous negative interaction with the ER manager, negative outcome with this patient and somebody is trying to cover her/his butt. I'd be curious to know what travel company you were with and what their response was.

[nuangel1, BSN, RN]

i agree i would do same thing since pt was hemodynamically stable.

[Creamsoda, ASN, RN]

One of our nurses got reamed out by the doc in ICU because she didnt hang the antibiotic fast enough in a septic patient. If it was a new antibiotic, then yes I would have hung it right away, rather than the blood if the patient was stable.

Cher

[busyernurse, BSN, RN]

I hate that you were done that way, but just like some other posters said, it's their loss. Speaking from an ER nurse and also med surg ch. nurse, I would have done the exact same thing. I don't think you did anything wrong, you were acting in the best interest of your patient.

TazziRN and Tweety both hit the nail on the head as far as the patient being at risk for being septic, and with a dx of cancer, she could crash easily waiting on the IVPB instead of the blood. And TazziRN's comment about blood versus initial dose of abx, it takes SO much longer for a unit of blood to infuse when you can infuse a IVPB faster and then be ready to hang blood or send her to the floor to get the blood.

Like I said, it's their loss!

[UtErRnEmt]

thanks everyone for your input. as for jojo's comment i had butted heads with one of the charge nurses the day before because i got tired of her dumping on me so that was probably a factor (nobody told me i was suppossed to be seen and not heard on travel jobs). to the best of my knowledge the pt had no adverse reaction to the delay in blood admin.

[Larry77, RN]

thanks everyone for your input. as for jojo's comment i had butted heads with one of the charge nurses the day before because i got tired of her dumping on me so that was probably a factor (nobody told me i was suppossed to be seen and not heard on travel jobs). to the best of my knowledge the pt had no adverse reaction to the delay in blood admin.

Sidenote: Travel nurses and agency nurses are famous for getting "dumped on"...not that it's ok but charge nurses tend to watch out for their own and dump on the non-core staff (this includes floats from other floors).

I agree with what you did and unless absolutely critical I do not start blood in the ED unless they are not being admitted or it is a trauma.