fluid infusion.. overload?

[fuyuojo]

I was endorsed a 3 y/o male with bronchitis. We did the endorsement on the station. He had a skin test that needs to be checked. So after endorsement, I immediately went went to his room after and checked the skin test (I know the doctors should do this but that's how we do it in the hospital). I noticed that the IVF was already consumed! H was hooked with D5IMB 500cc x 46-47mgtts/min. I stoped the infusion and called the resident on duty to have an IVF to follow. He had not assessed the patient when he came up since I haven't told him what had happened. I got lost and I didn't know what should I do. I hooked the bag, maintained it on KVO and observed the patient for signs of circulatory overload. A few minutes later, the patient urinated a lot, which might be the way the body compensated for the fluid that had been taken in. I called the resident again, to have him checked. Thankfully, he said the patient was alright, as he is not dsypneic or tachycardic. I endorsed what had happened the next shift. Unluckily, I didn't write what had transpired that day, nor the level of IVF when I had received it. I asked the mother if someone did regulate the IV when they were still in the ER and said that they were not attended anymore after inserting the catheter.

Now, the pedia was looking for me, and she is fumed. I wonder if I should tell the nurse supervisor first or go and tell the pediatrician what had happened? I am really scared, I'm new at work and I don't know what should I do.

[Jjearkwein]

(there was insufficient info about the IV)

but for what i understand you received the IVF already consume, then its not your fault... its very common to loss regulation especially on unattended pt due to positioning and other circumstances(these frequently happens on public hospitals)....

the mistake you have done is not telling the ROD what happened, and not charting it as you received it. if the endorsement is not done at the bedside,i usually take the cc level of iv first before doing anything else(its also a safety measure for yourself that what they endorsed is accurate on what is) ...

[CNL2B]

You are obviously not an American nurse, so some of the terminology you are using is hard to interpret. From what I can get out of this --

Does not look to me like your patient has signs/sx of fluid overload. This was an error, but it doesn't look like it had adverse affects.

For pediatric patients, most hospitals in the US have precautionary measures in place to make sure large amounts of fluid don't infuse rapidly. Was the IVF on a pump? Most pedi patients here per policy need to have their fluid on a pump, if not on a buretrol as well (an extra chamber you can dump the IVF in, so with a maintainance, not more than 2 or so hours could infuse.)

You should look at your policies and make sure there wasn't something that the ER nurse or yourself missed. Probably an incident report should get filed, which usually involves notifying the MD.

[fuyuojo]

I did call the resident on duty and had him check the patient for signs of fluid overload, especially if there were crackles, etc.. Unfortunately, the IVF was not on a pump, the set that was used is the one with the roller clamp on it, a microset. He was hooked with a Balanced Multiple Solution that needs to run for 10 hours.

I know that I am wrong about not doing the endorsement bedside but even so, I always check the patient immediately after the patient was endorsed to me.

@cnl2b: i know. i have to file one now. and probably talking to my supervisor would help.

[NightNurseRN]

I could not follow the story line at all.

[kikwon89]

What do you guys mean when you say "endorsement bedside"?

[fuyuojo]

that means when receiving the patient from any unit, endorsements should be done in the patient's room, beside his bed. hence, "bedside endorsement".

[fuyuojo]

to cut the story short, i received a pedia patient from the ER with an Intravenous Fluid already consuming that needs to run for 10 hours but was infused in 1 1/2 hour. did call the resident to check up on him, but nevertheless no documentation done (that IVF is consuming). no bedside endorsements done.