Anxious Patient, Possible Biliary Drain Dislodgement, and Nervous Nurse-HELP!

[blackdiamond407]

Hello All! Advice desperately needed. I am a nurse of 5 months working in sub-acute care and I still have a lot to learn. I was changing the dressing on a pt's biliary drain the other day. The tubing of the drain is stitched in the skin. When removing the old dressing, I pulled a little on the drain and the patient said it was painful. The drain remained in place. It did not become removed from the site. Stitches also remained in place. I finished removing the old dressing and placed a new one. The patient is one of those patients that is always asking questions. Every day she asks if her doctor knows what she's taking and she always thinks something new is wrong. I am constantly calling the MD to ensure that what she is worried about is to be expected (which is always is) and I am constantly documenting because she is always making comments like, "everything here is so disorganized regarding my care!" Which is not true. She is just anxious. Anyway, today when changing her dressing she stated that she is afraid that the drain was dislodged the other day. Now she has me worried because she is saying it so much and I am still a new nurse. She is going to the hospital for a procedure tomorrow. If her drain is dislodged, is this something that I will get in trouble for? Or is that something that they will just fix at the hospital? Just another general question. I change a lot of PICC line dressings and I am always worried they will be dislodged. If someone's PICC line is dislodged is this something the nurse will get in trouble for? Or would they just send the patient back to the hospital to get a new one? Are these scenarios cause for a lawsuit? I realize that we are supposed to try to keep these items in place but I also feel that human error does sometimes happen and I am wondering what happens in these scenarios. Any advice is appreciated. Thanks!

[Lev, MSN, RN, NP]

I think her nervousness is rubbing off on you. Breathe! It will be fine. You assessed the nephrostomy tube site and the stitches were intact, so it should be in place. If it were truly totally dislodged, there wouldn't be any drainage. I don't have enough experience with PICC line dressing changes, but I would imagine that as long as you're careful it should stay in place. I don't think they slip out as easily as IV catheters.

[blackdiamond407]

Thanks! I think you are right. Sometimes an anxious patient can make you anxious, especially if you are still in the learning process. I am quite sure that her tubes were not dislodged as the patient went to the hospital for a procedure and I did not get any messages that the tubes were indeed dislodged. Thanks for the advice! Much appreciated!

[AgentBeast, BSN, RN]

Yeah no, you aren't going to easily pull out a biliary drain, and you aren't going to pull out a PICC line doing a dressing change.