Forgot to unclamp the secondary

[DH1234]

I am on orientation still, and I been making mistakes. No serious med errors or any mistakes that has caused harm to the patient. However, this morning I hung an IV antibiotic, and I am pretty sure I forgot to unclamp the secondary tubing. I think I made the same mistake two weeks earlier, but after that I never made that mistake again until today I think. I am pretty sure if it happened the day shift nurse caught it. But I feel so stupid. I do not know why I keep making this mistake. I do not want my preceptor and other nurses think I am incompetent. I honestly feel awful because I sort of delayed his care.

Does this happen to experienced nurses sometimes? I know this a mistake, but is it something I should lose sleepover. Have you ever heard of a nurse getting fired for this? I honestly feel so awful.

[HelloWish, ADN, BSN]

This is a common mistake with experienced nurses. I have just learned to go back and check later on to make sure everything has run as it should if possible. If I catch another nurses mistake who is already off shift, I just correct it.

[Waiting for Retirement]

There's an old saying, that if you come across a nurse who tells you she has never made a med error she's either lying or just too stupid to know the difference.

People make mistakes. If you're lucky they're small. Nurses of all experience levels make mistakes! This was minor, nothing to lose sleep over and likely caught by the next nurse. That next nurse should have looked over the IV after getting report and seen that the med hadn't run, and then run it.

If you aren't concerned about small mistakes when you're new it would tell me you're going to be a problem nurse later; you have a good conscience and that matters. Learn from mistakes, teach others, and move on ?

[CalicoKitty, BSN, MSN, RN]

I've seen that happen often, and even some nurses that forget to mix the powder into the pouch, so I find an empty bag attached to a vial of powder. Recently, a well experienced nurse, did that with 2 of my patients. It happens, but it can cause harm when a patient misses a dose if the bacteria learn antibiotic resistance.

Make a habit that when you start the fluids, make sure you see a few drops start from the correct bag.

You can fix the problem sooner if you make a habit of checking on your fluids well before shift change (at 4 or 5, since 6 is often running around time). So, when checking your continuous fluids (so the next nurse doesn't have to change a bag right away), you can make sure the antibiotics were completed. Maybe also make a habit during hourly rounds.

[MunoRN, RN]

There's something to learn from every mistake. Something to consider is that there's no reason to clamp the secondary, ever. If you don't clamp it then you don't have to worry about remembering to unclamp it.

[NM1Nurse]

Very common mistake that new and old nurses make. I am sure every nurse has done this--probably more than once.

I always squeeze the primary bag slightly and ensure the fluid flows up into the secondary bag chamber before walking away. Sometimes the secondary tubing can be attached to the primary not quite right and cause the secondary to not drip or to drip slowly. If I squeeze the primary bag and fluid does not go into the secondary chamber, then it means either my clamp is closed, or the secondary line is not connected correctly to the primary (even though it looks like it is). If it takes a lot of pressure to squeeze the primary bag for the fluid to go to the secondary chamber it means that the secondary line is not attached correctly to the primary. Doing this also ensures that there are no air bubbles in the line that will cause a pump alarm and force you to come back a minute later.

I like this method more than the watching for the secondary chamber to drip because it is faster (takes 1-2 seconds), removes air bubbles, and ensures that lines are connected properly.

Having a set routine with double checks that you follow is important. If you double check yourself every time you will eventually do it efficiently and without even thinking about it. Not only do double checks prevent mistakes but they can save you a lot of time through your shift. This applies to a lot more than just IVs.

[Pepper The Cat, BSN, RN]

I once hung 4 0600 am antibiotics and forgot to open the clamp on all of them. I had been a nurse for at least 10 years when I did it. Sometimes your brain just forgets things. It happens. Now I take the extra minute to stand there and watch for the secondary bag to drip.

[CalicoKitty, BSN, MSN, RN]

4 hours ago, MunoRN said:

There's something to learn from every mistake. Something to consider is that there's no reason to clamp the secondary, ever. If you don't clamp it then you don't have to worry about remembering to unclamp it.

Half the time, if I don't clamp the secondary, the primary runs back and then starts to drip and pours all over the floor and I look like an idiot (and maybe the floor gets sticky). I'd rather not unclamp it, but I end up making a mess if I don't.

[mph53953, BSN, RN]

Honey, if unclamping a secondary is the worst mistake you’ve made, you’re doing great! It’s easy to feel like you’re making silly mistakes and forgetting things because when you’re on orientation (especially if you’re a new grad or in a new specialty) your brain is literally being bombarded with an overwhelming amount of information. Hang in there and stay positive- it gets better ❤️

[db2xs]

I'm going to echo what everyone else is saying: It's happened to all of us. I've seen experienced RNs do a lot "worse."

If it's just a secondary ABX, you or the next RN can always retime the subsequent infusions, as long as not too much time has passed.

[Ddestiny, BSN, RN]

Whenever I have a student or I'm precepting a new nurse, I point out one of my favorite pieces of advice to avoid this very common problem:

Always make sure that the correct drip chamber is dripping before you move onto the next task.

That being said, it still doesn't make me immune from making the same mistake, especially if I'm in a hurry. ?

[Skips, MSN, RN]

This happens a lot! Your hospital may implement something to help decrease this issue.

I wasn't taught to "back prime", but many nursing schools are teaching students to start back priming their secondary bags. You hold the secondary bag below the primary and prime the tubing and get rid of air that way. Then, hang the bag and start the drip via the pump.

The other method (the one that I use) is a reminder in the MAR when I scan the medication into EPIC. There is a reminder that must be clicked to verify that you see drips in the secondary bag before you can finish with administering the medication in the MAR. This is extremely helpful for me, and I am glad that my hospital has it built into the system.

Are you able to fill out an incident report for this? Encourage other nurses to do the same thing so the hospital can track issues and work on implementing something to decrease the incidence of it. It happens a lot.

We've all made this mistake, trust me. You're doing great.