First mistake hanging blood

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Specializes in med surg/telemetry.

Hi. I have been beating myself up about my first mistake in nursing. Im a new rn grad and have been on tele for 3 weeks. My pt was chronically anemic and has received blood many times. when i arrived for my shift the other shift nurse showed me how to hang blood and this was the first time i did it myself instead of watching. my preceptor is great but let this nurse guide me. (i have 3 pts for the first time) so, it was started at 50ml/hr with 400ml to infuse because thats what the nurse starts it at i guess. my dummy self, even though i know blood should be infused over 4hrs or less left it at 50ml/hr. after 5 hrs of start time and lab wondering when they can draw an h and h i finally asked my preceptor if i could increase it. i know!! dumb! she quickly infused the rest and apologized for not paying more attention. i apologized and blame myself. the pt was fine without reaction and the h/h increased to norm. i felt overwhelmed with the blood, 3 pts, a discharge @ the same time, accu checks rn's have to get, the phones, and the "new jitters". what happened?? can anyone relate....advice please.

thanks:)

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You need to stop beating yourself up. You made a mistake and learned from it. I will bet that you never make that mistake again. I am a new LPN going to school for my RN, and I just started a job at a nursing home. I have been on my own now for about 3 weeks, after 5 weeks of training, and there is so much that I do not know, everyone keeps assuring me that things will eventually come . Tonight I finally wrote out an order for Roxanol to put in the MAR'S and actually felt confident about it. It is the little things that I conquer that make me feel good. Good Luck to YOU

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Specializes in ICU, telemetry, LTAC.

Question for the OP: Do you use a form for frequent vitals when infusing blood? If so, this tip's for you. Put down the time you signed out the unit from the lab on it. Like I put pre-vitals. Then one line has time started and the little sticker from the blood on it with the unit number/donor number. On that line I put Signed out of lab at ____. after the sticker.

That reminds me that it's not what time I started it that matters, it's the time I got it from the fridge.

This is something that comes up on our unit with transfusions that cross over a shift, and many do. I always point out "see we're on this unit, I signed it out at ____ so you have until ____ to get it done ok?" Once we had a cross-shift transfusion that took 6 hours. Our manager was not happy with us, so I started doing this.

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Specializes in ICU, Telemetry.

First, I hang the infusion set, get it primed, and I contect up the line and run NS at 100 cc/hr for about 5 minutes, to make sure I've got good access before I go for the blood/FFP/PRBC/whatever (cutting it down to KVO before I go for the blood). Nothing worse than getting the "pink" to the patient and the vein blowing or finding the "KVO" that's been working fine all night was not going to take a 100 cc/hr.

Don't forget to zero the pump to get an accurate count of ml passed.

We have white board in each room. As an example, I might write the following for something with a 4 hour window:

Time out: 2135 7/26/08 MBDB (must be done by) 0135 7/27/08

vitals at 0

vitals at 15

vitals at finish (and this can be the beginning vitals for the next bag, if more than 1)

While it's also on the form we send back to the lab, it also lets everyone else who comes into the room know where I'm at in the process -- what if I had a patient code and someone else had to come in behind me? Assume the worst, and you're covered for everything else.

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.

That's how you learn best sweetie,you didn't hurt anyone and you won't make that mistake again.

The best way that I've learned is to have a small sheet of papers(s) will all pertinent data,labs/vitals/when accuchecks are due and I write down on that paper when the blood has to come down if it's hanging between shifts.Also always look at the blood sheet to make sure the previous shift signed everything and that the vital sign paper has been started and filled out.

You will learn how to prioritize things at the beginning of your shift,how to delegate things(like accuchecks to the techs) and how to deal with the constant interruptions that are part of being a nurse in an acute care setting.

I'm glad that you like and can communicate with your preceptor,ask her or any nurse that you're working with any questions and tell them if you feel overwhelmed and have them work out why so they can help you prioritize,that's very important.

When I was precepting new nurses in the high stress areas that I worked,if I found out that the new nurse always asked questions when she was stuck I felt SO MUCH better and more confident about her/him.

You are doing fine,:yeah:keep going back there,keep learning,keep asking questions!!

We need you!

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Don't fret over it as you learn as you do. Sometimes we get so busy that its the things we worry about that gets missed. I have done that also(leaving blood at start rate)and I have been an rn for 5 years. You get caught up in doing the multiple things we are responsible for and it happens. Sounds like you have a good preceptor

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Specializes in ICU.

It's gonna happen. What I usually do is just program a 15 minute infusion so the pump starts beeping if I don't get back in time to take my 15 minute vital signs. Then I bump the rate on up during this time. HOWEVER, make sure your patient has started getting the blood before you take your 15 minute vital signs..I've seen several nurse get the vital signs but the blood has never even made it all the way down the tubing...so the vital signs really don't matter.

Just wait until you spike the blood bag and your "spike " doesn't take...and it comes back out and you, your patient, the wallpaper, the bed and everything else gets a blood bath. You look like a Kotex heavy days walking around :) but it's all good. Stuff happens.

I remember the days of thinking 3 patients were a lot...however, now I'm used to having 8 or 9 patients with 4-5 discharges per day..and then getting 4-5 admits back, no task nurses, nothing...just you and the patients...

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Specializes in Cardiac Telemetry, ED.

The patient was not harmed, and you learned something. Don't beat yourself up.

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Hi. I have been beating myself up about my first mistake in nursing. Im a new rn grad and have been on tele for 3 weeks. My pt was chronically anemic and has received blood many times. when i arrived for my shift the other shift nurse showed me how to hang blood and this was the first time i did it myself instead of watching. my preceptor is great but let this nurse guide me. (i have 3 pts for the first time) so, it was started at 50ml/hr with 400ml to infuse because thats what the nurse starts it at i guess. my dummy self, even though i know blood should be infused over 4hrs or less left it at 50ml/hr. after 5 hrs of start time and lab wondering when they can draw an h and h i finally asked my preceptor if i could increase it. i know!! dumb! she quickly infused the rest and apologized for not paying more attention. i apologized and blame myself. the pt was fine without reaction and the h/h increased to norm. i felt overwhelmed with the blood, 3 pts, a discharge @ the same time, accu checks rn's have to get, the phones, and the "new jitters". what happened?? can anyone relate....advice please.

thanks:)

Your preceptor should have been keeping a closer eye on things. Don't worry, you'll never do it again! We all make mistakes!

Hang in there!

Oldiebutgoodie

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Specializes in Telemetry.

You know, honestly I'm impressed that you were capable of being responsible for three patients, with a discharge and blood infusion among them. I'm a new nurse on a telemetry unit but I've been there for 10 weeks. My preceptor did things differently, I've always had all 5 of our patients, but she reminds me of stuff we need to do and signs off orders for me. My orientation is 12 wks. I'm still not capable of taking all 5 of my patients and doing everything for them without her help and she has let me fall behind many times in attempts to let me handle it. For example, I had a patient with a chest tube. I went in at the beginning of my shift and did the assessment looking at his chest tube atrium. It did not click for me that the suction was not working and when the NP came to see him she was a little upset about it to say the least. I felt so bad because it is something I should have caught and then I felt worse because my preceptor stood up and took the heat for me. I don't feel like it was her fault at all. If I'm suppose to remeber all this stuff in two weeks I should be cabable of doing at least 85% of this stuff on my own now. Or at least that is how I feel. All I see in my future is getting off of work two or three hours late every evening and not really getting any days off because I'll be having to study on my days off. It is really kind of depressing to me because for the last 3 years I've been a student nurse tech in a hospital that has a 65 bed ER. There I was capable of handeling 16 patients and the needs of 4 nurses. Why can't I keep up with the 5 patients I have now? Everyone tells me that I'm never going to feel ready to get off orientation. If that's the case how do I know my patients will be safe if I'm unsure with what I'm doing and constantly forgetting things that need to be done?

I'm unsure if that will really help you feel better, but at least now, maybe, you know you're not alone.

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