CRRT: My Mistake

[BC1441]

I feel like a terrible nurse. I am a fairly new nurse and usually work in the PICU. I pride myself in being very safe and I am not afraid to ask questions at all. I am orientating to the SICU to help out while all this COVID stuff is going on. I expressed to them my fear with taking CRRT because I have never done it in the PICU. They said that they would never do that. My second day I was given a pt that was on CRRT (I still had a preceptor who told me they probably just did it cause I was with her - I only got two days of orientation). I am always up to learn new things so I was asking questions and taking it all in. I have help out in the PICU before and all they have to do in the SICU is switch out the bags and troubleshoot. So the first bag needed to be replaced. My preceptor mixed the bag - which I did not see and I hung it with her watching me and she said I did it right. The next time she was in the room with me, but I was fairly confident because she had watched me do the first one. However, I did not mix the bag!! I didn't even know I needed to do this! I was never taught. Yes I should have realized, but I didn't. She was also in the room with me. So it ran until the machine started beeping something was wrong and I got her immediately. We couldn't return the blood because there was air in the line and he probably didn't get the right stuff for about 4 hours. They wanted to switch him the HD anyways and his labs actually looked great, but I feel horrible and like a terrible nurse and cannot let it go. Everyone told me it has happened before but I just don't know if it has and I feel like I shouldn't be a nurse or should be fired.

[Hoosier_RN, MSN]

No you shouldn't be fired. Learn the lesson and move forward

[flo136]

I did something similar years ago learning CRRT but forgot to document the fluid off amounts. I felt like rubbish because they thought I was a 'good' ICU nurse.

However, the nurse in charge told me the problem, the solution; they fixed it up on the chart and said don't do it again. And they're right. As mistakes go, its not that bad and they've probably forgotten the event so you should too.

Its really not that bad- there are far worse that goes on in ICU.

[catamounts30, BSN, RN]

First of all I’ve been there. This is not just you it’s a common mistake that happens all the time in fact most pharmacies don’t issue the solutions like this due to this fact. Secondly aside from some mild electrolyte derangement I’m sure you saw that your patient is fine. CRRT is a pain to get used to in the beginning especially if you have a weak nephrology service that is new to it or poor nurse education/orientation/support. Either way you can over come all these hurdles and will get a great handle on it; go in there like a boss, soldier on and take crrt all the time. We are all perfectionists in critical care and are extremely hard on ourselves for the better and sometimes worse. You kept that kid alive; keep it up and take more of them.

[ljo28, BSN]

In my facility we usually hang 4 bags at a time and the machine supposedly pulls evenly from each bag.

If you changed one bag and forgot to mix the solution should not be a big deal. No this is not good enough of a reason to fire you or even a disciplinary action because first off, you were not given a proper orientation. You were not in your regular area of work. Secondly those bags are electrolyte solutions, and the patients on CCRT usually are ordered frequent labs. If there was any critical lab results, they would have been taken care of. So, if you'd ask me, I'd say learn from your mistakes and move on.

[lexotaNIL, BSN]

the best experience is first-hand experience whether it is wrong or correct. always give yourself a room for failure because that is where you'll gonna learn much.

[ljrn135, ASN]

Being a newer ICU nurse I totally get your hesitation; however, accidents happen and this is not that bad of one anyways. You will get past this.... and this ONE incident in no way makes you a bad nurse nor should it affect your employment! Good luck and don't be so hard on yourself!