compartment syndrome-did I cause it?

sloydrn · May 4, 2004

Compartment syndrome is a (fortunately rare) complication of IV infusions that are placed in the extremities that contain the compartments. You cannot control how the person's compartment will react to an IV infusion. Even if it appears "patent" if the arm becomes engorged, etc, the proper action is to dc the IV, notify the physician, administer antidote if applicable, etc. The IV does not have to be caustic, it can happen with just plain run-of-the-mill common fluids. From your description, it sounds like you took proper action and kept following up and documenting what you did. Sometimes people just get complications, you can't prevent them all, just be prudent in your follow up and keep the physician and /or your nursing supervisors apprised on an ongoing basis. It sounds like you did just that.

It can be intimidating to 'appear' before the 'judges' of risk management, administration, attorneys, etc. They are going to be concerned with possible litigation and mitigating their exposure and ultimate damages ($) they may have to pay out. As they say, hindsight is 20/20. Don't feel like you are to "blame" for the compartment syndrome. As long as you did what a reasonable and prudent nurse would have done in that set of circumstances, you met the standard of care. Even if you met the standard, the patient can still sue the hospital, but if your actions were within the standard of care, the hospital will have a much stronger argument to lessen the damages. Just keep doing what you know is right, and initiate the chain of command anytime you feel uncomfortable/unsure in a situation. Live by the motto: Bring 'em down with ya!"

AZEMS · May 17, 2004

You charted well. Its easy to look back and tear your chart apart. You charted the facts and notified your findings approriately. The fact is something horrible happened that could be prevented again. Not because you did wrong but, because things took place that indicate a problem starting.

Phenergan is a nasty drug. It works well and causes many side effects. I myself now chart and change and teach a new way of giving it. I mix phenegan in 50cc solution as a drip over 5 mins. I notice no burning complaints or EPS-tremor reactions since.

You could say in your sceniro that the first indication of burning should of caused you to pull the IV notify the doctor and establish close monitoring. A panel of expert nurses would agree. However, several nurses would agree that you had a running order and was prudent in your care as any other nurse would. Others would argue that keeping her as an admit caused some potential harm. Either way learn two things.

Always dilute Phenergan documented in research needs to be 20cc I use 50cc

Always take consideration to D/C an IV after one issue of burning--repetitive events cause greater potential for harm.

Take pride of what you did giving the circumstances before knowing the outcome and learn from your experiences

zacarias, ASN, RN · May 17, 2004

Always dilute Phenergan documented in research needs to be 20cc I use 50cc
Always take consideration to D/C an IV after one issue of burning--repetitive events cause greater potential for harm.
QUOTE]
I say the diluting phenergan with 50cc NS is a good idea. D/Cing every IV that burned with Phenergan would be nice in a perfect world but so many say it burns even when diluted and it's on an IV in the extremities. Some of these patients say that saline burns them going in. While the IV could be infiltrated, it also might be fine in the vein.
Until each nurse's hospital makes it the policy to only give Phenergan, Potassium etc...via a central line, there will always be conjecture and nurses saying "oh it's OK to give through the hand" or "it's never OK to give through the hand."
It's highly problematic because just 'cause you dilute phenergan in a 50cc bag of saline does not mean the next nurse on your shift will.