grrrrrrrrrr.........

[luvkitties]

:madface: My dad is in the hospital and is getting IV antibiotics...the cannula became dislodged, so he needed a new IV. This "nurse" (and I use that title loosely with this person) came in and made several errors...first, she chose to restick my dad BELOW the original site...then, she put the tourniquet on and THEN decided that it was time to set up (open her needle packaging, get the tape/tegaderm ready, etc). At this point, I was seething, but I held my tongue...then, she sticks my dad (abbocath was a needleless system) and pulls out the needle with HALF OF THE ABBOCATH STICKING OUT, AND SHE'S TRYING TO FLUSH IT!!!!!!! :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

So, after trying that for a minute, she finally decides (hello!?!) that it's not going to work, and that she needs to restick him. I whispered under my breath "I'll do it"...she must've heard, because she asked if I was a nurse...I said I am...she asked if I wanted to start his IV, and I said "sure", and that my instructor had told me that I was one of the best IV starters in my clinical group. She procedes to insert another IV (again, distal to the other sites) and does get it in this time...only, she doesn't bother flushing the cath/port after insertion, which had blood in it...oh, did I mention that she wasn't wearing gloves during any of this? She ended up getting blood on her hands...talk about stupid. Luckily for her, my dad is "clean", but the next person may not be.

After all was said and done, she was about out the door when she turned around and said "IV starts aren't anything to brag about...I've been a nurse for 27 years". I couldn't believe that she said that...first of all, I didn't think I was bragging, second of all, with all of the errors she made, there's no way I would have imagined her being a nurse for 27 years! I am really PO'd at how unprofessional this person was and I am very tempted to report her.

Thanks for listening, just needed to vent :madface:

~Lori

[meownsmile, BSN, RN]

Km5v6r....... i was thinking of my aunt when i wrote,, but hesitated.. You put it well. Her philosophy sounds very similar to yours. And i have to admit,i strip a glove now and then for a tough stick and other things too. Sometimes you just have to.

[P_RN, ADN, RN]

She should have worn gloves.

Otherwise everyone has a bad day in IV land.

However, a flash means the tip is in the vein, what she did with the saline is try to float the cath furthur in; the saline would open the valves ahead of the more dense tip.

The tourniquet is to obstruct venous flow so the vein distends. Arterial flow should still continue.

Opening the equipment should take about 10-15 seconds including putting on the gloves.

Distal starts are OK providing the vein used earlier isn't proximal to the attempt.

Sometimes veins "clamp down"after a stick. And I too have left an earlier cath in so this wouldn't be the case on the second attempt. And BTW 2 attempts should be all.

I don't leave my patients looking like porcupines sprouting Jelcos.

=====

OK I've said all that.

Been there done that:

(1) FIL in midst of 2nd acute MI they put him in the rig and didn't leave.....I walked out and asked what was the delay. Medic [and I don't think he was a paramedic, but an EMT] said "we can't go til we have an IV access." ME: "get out of the way and I started an 18g."

(2) MIL small town ER sick as a dawg nurse can't get IV

ME: see #1

(3) MIL in same small town ER ......nurse can't get a foley

ME: see #1 except it was a 16g foley.

Family should allow the staff room. They are trained, they are experienced. It is agony watching family members in pain. I felt like an (insert term for donkey) butting in, but the staff had given up and relative was in agony.

I hope things are better for you now. I absolutely know how you felt.

[PedsER-RN, BSN, RN]

:madface: my dad is in the hospital and is getting iv antibiotics...the cannula became dislodged, so he needed a new iv. this "nurse" (and i use that title loosely with this person) came in and made several errors...first, she chose to restick my dad below the original site...then, she put the tourniquet on and then decided that it was time to set up (open her needle packaging, get the tape/tegaderm ready, etc). at this point, i was seething, but i held my tongue...then, she sticks my dad (abbocath was a needleless system) and pulls out the needle with half of the abbocath sticking out, and she's trying to flush it!!!!!!! :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

so, after trying that for a minute, she finally decides (hello!?!) that it's not going to work, and that she needs to restick him. i whispered under my breath "i'll do it"...she must've heard, because she asked if i was a nurse...i said i am...she asked if i wanted to start his iv, and i said "sure", and that my instructor had told me that i was one of the best iv starters in my clinical group. she procedes to insert another iv (again, distal to the other sites) and does get it in this time...only, she doesn't bother flushing the cath/port after insertion, which had blood in it...oh, did i mention that she wasn't wearing gloves during any of this? she ended up getting blood on her hands...talk about stupid. luckily for her, my dad is "clean", but the next person may not be.

after all was said and done, she was about out the door when she turned around and said "iv starts aren't anything to brag about...i've been a nurse for 27 years". i couldn't believe that she said that...first of all, i didn't think i was bragging, second of all, with all of the errors she made, there's no way i would have imagined her being a nurse for 27 years! i am really po'd at how unprofessional this person was and i am very tempted to report her.

thanks for listening, just needed to vent :madface:

~lori

i'm not familiar with the 'abbocath' system, but she might have hit a valve and decided to try to float the iv in with the first stick.

there's many occasions when i put the torniquet on and then set up.....it lets the veins fill.

saying your instructor said you're one of the best iv starters in clinicals doesn't say a whole lot.....it takes dozens of sticks to be considered competent, at least imo.

it doesn't matter how 'nice' your dad's veins are. depending on medications, illness, hydration, and many other factors, they can be more fragile and make it harder to start an iv.

i think it's pretty sad that you've judged a nurse simply on her ability to start an iv. she was pretty patient with you; while i feel sorry your dad had to be stuck more than once, i feel more sorry for her for having to put up with your attitude through the whole thing. and yes, i know how it feels to have a family member stuck more than once. that's no excuse.

[luvkitties]

Lori,

I am not sure what to say here, but I really feel like I need to respond. My Dad as well has had a hospital experience recently. He was in for about 6 weeks. It is extremely difficult to sort out my feelings through this experience. What we are taught in school is quite different from what happens in the "real world" and we both know that. We are students. Yes, we have knowledge, and we are pounded with the way things "should" be done. It is really tough to keep perspective through a personal time.

How many times in your clinical experiences have you seen nurses cut corners, or do things not exactly the way you were taught in class? Were you this upset when you saw something like that? I am not saying your feelings are out of line, because when it is a family member, it is quite different.

I do feel for you, and I have watched my own Dad go through some things that I didnt feel were quite right. He was dropped on the floor, he was given a pill that was picked up off the floor, he was not given safe D/C instructions. The list goes on and on.

I have had to sit back and truly reconsider my even becoming a nurse after this. But I am moving forward, and determined to make myself a nurse that will make the time to do things to the best of my ability.

This is a difficult field, and the pressure is astounding. Starting an IV a different way then you were taught is tough to watch. But we cant put ourselves in their shoes until we are there.

From both sides of the fence this is a difficult situation. Keep your compasion, for your Dad, as well as the nurse that was working with him. We are all really on the same team.

Hope your Dad is well on his way to health, and hope you are feeling better about this experience.

~ear

Thank you so much for your response...it's nice to know that there are nurses on this board (you and a few others who've responded) who aren't ready to jump down my throat and criticize my feelings. I thought nurses were supposed to be better than that.

Yes, there were times during clinicals when I have seen a nurse deviate from what I was taught...I wasn't angry (at the clinical nurse), just confused...I know that not everyone does things *perfectly*, and I realize that someday I may find myself not doing things to the letter...but I definitely want to be the best I can for my patients' well-being.

I'm sorry for what you and your dad had to go through...I hope you are both doing well :icon_hug: I guess all I can say is that witnessing others' ways of doing things (whether correct or not) can only influence us to better our practices in the future :wink2:

Thanks again for your comforting words :icon_hug:

~Lori

[Medic/Nurse, BSN, RN]

For some strange "reason" IV's tend to be a "sticking" point with many patients "family". I can understand the anxiety - but, come on - I cannot imagine that any nurse would not give the all out best effort to this procedure.

I had a recent case where the patient was elderly, paper thin skin, weighed 80#, had been to 3 other hospitals in the area over the past 4 days (treated in the ED and released for abd pain/UTI) and had the type of "visible" veins that were the size of thread. Oh, and she was covered in bruises from prior care.

I had found a barely palpable vein just above the AC and was all set up to "stick" the patient when the patients daughter actually grabbed my forearm. I stopped and asked:

"What are you doing?".

She replied, "that I'm just going hold your arm so that I can make sure that you do not get the opportunity to 'gouge around', I've seen other nurses do that, and this will make sure that you don't".

I'm not sure how I managed to remain restrained.

Well, I should have just stopped right there - but as all three nursing techs had been in and could find nothing and all refused to try the IV - and we needed to get this done I proceeded. (Keep in mind I've done many thousands of IV's and there is no "IV nurse", etc.) I proceeded with the IV stick, got great flash and was attempting to advance the cath when the shaking from the daughters grip proved the attempt unsuccessful. So I took out the cath, dressed the area. The daughter merely said. "I don't want her stuck anymore". Fine. I just told the MD that they refused the IV, that vascular access was near impossible and he could proceed with the family on placing central access or going AMA. I would not be sticking her again.

Well, to make a long story a bit more concise - the ED tech got around to the EKG and it was the worst one I'd ever seen. BIG, huge complexes that could be nothing except hyperkalemia. Well that changed things pretty fast.

(Yes, the patient was a bit altered, but she'd had demential and was given IM phenergan in the PCP's office about an hour PTA). The IV went in the foot with no blood return but excellent flush and the CaCL, Insulin and D50 all got pushed through it without waiting on the labs (that were obtained via 25 gauge butterfly with only 2 ml return near the shoulder). The patient had a K of 9.1, yep that is right NINE point ONE. (She had been treated for low potassium just 3 days earlier).

Moral of the story: The behavior of the family with the matter of the IV took up quite a bit of time. No one was thinking issues with K as the patient had a fever with pretty yucky urine - and the fact that she was a bit altered - did have obvious other causes. Thank God we did yet another pristine work-up that included an EKG. Time that was wasted with the "IV issues" could have very well led to a different outcome for their precious mother. Luckily, it all worked out okay. (After 2 central lines, RSI and placed on a ventilator and emergent dialysis - pt did not have any renal history, an ICU stay of 6 days). This patient was discharged to home without complications.

I WILL NEVER ALLOW FAMILY TO CONTROL THE IV PROCESS (OR OTHER NECESSARY PROCEDURE) AGAIN. AND ANY COMMENTS THAT BRISTLE ME - WILL ASSURE THAT THE FAMILY CAN "OBSERVE" THE IV INSERTION FROM THE COMFORT OF THE WAITING ROOM.

I take my job very seriously - and I consider myself very skilled in technical procedures. I take great pride in being an excellent clinician. I think questions can be asked and do educate the patient/family at every opportunity. I am all for self direction of care and do respect patients right to choose - but for those family who insist of being "superior" and hostile in comments/questions/physical interference of any procedure - I think the waiting room can be very helpful in controlling their anxiety.

Practice safe!

[TazziRN, RN]

Luv, I understand what it's like to be on the family side of things, and I'm sorry you were in that position. I have had both parents, MIL, brother, and both daughters in the hospital and each time have kept my eyes open. HOWEVER.......and this is the biggie.......you made a snide comment in front of the nurse while that nurse was attempting something with your dad. If I had been that nurse it would have rankled even more that the comment came from a new nurse. I too am an older nurse. I was not taught to do things with gloves unless it involved stool or a sterile procedure. To this day, no matter how often/hard I have tried, I have not been able to start IV's with gloves on unless the pt had garden hoses. Hence, most of the time I do not wear them. Then again, I have been poked with dirty needles while wearing gloves, so gloves are not the prevent-all. And I have often restarted IVs distal to the current one. Doesn't matter as long as it's not the same vein.

I'm rambling here. The point I was trying to make was that yes, you have/had feelings about this nurse. What about her feelings? You humiliated her in front of your dad with your comments. If you had to make them you should have made them in private. Just based on what little we know from your post, the only thing she did wrong was not wearing gloves. Otherwise her technique was fine.

Something I remember my nursing school instructors telling us over and over: "Learn the way we teach you to pass your boards. Then go out into the real world and learn how they're really done."

[CoffeeRTC, BSN, RN]

You had me until you spoke of "your clinical instructor said..."

Any nurse would have been upset with that...how about you?

Ditto what everyone else said.

Now...I've been and observer at times when family has been in the hospital and have said things when actual harm could occur...like someone trying to reattach the iv to the HL after the tubing and connector were one the ground. That type of stuff.

I hate it when family tells the staff that "Hey...my dgter is a nurse....." Normally if talking with the staff or if they ask I will acknowlege it and maybe say..."Gee...I see how over worked you are...let me help by (making the bed..feeding gram..taking her to the bathroom...etc" I'm not there to judge, just help and visit.

[luvkitties]

Luv, I understand what it's like to be on the family side of things, and I'm sorry you were in that position. I have had both parents, MIL, brother, and both daughters in the hospital and each time have kept my eyes open. HOWEVER.......and this is the biggie.......you made a snide comment in front of the nurse while that nurse was attempting something with your dad. If I had been that nurse it would have rankled even more that the comment came from a new nurse. I too am an older nurse. I was not taught to do things with gloves unless it involved stool or a sterile procedure. To this day, no matter how often/hard I have tried, I have not been able to start IV's with gloves on unless the pt had garden hoses. Hence, most of the time I do not wear them. Then again, I have been poked with dirty needles while wearing gloves, so gloves are not the prevent-all. And I have often restarted IVs distal to the current one. Doesn't matter as long as it's not the same vein.

I'm rambling here. The point I was trying to make was that yes, you have/had feelings about this nurse. What about her feelings? You humiliated her in front of your dad with your comments. If you had to make them you should have made them in private. Just based on what little we know from your post, the only thing she did wrong was not wearing gloves. Otherwise her technique was fine.

Something I remember my nursing school instructors telling us over and over: "Learn the way we teach you to pass your boards. Then go out into the real world and learn how they're really done."

It doesn't matter as long as it's in not the same vein?!? Now why didn't my instructors tell me THAT?!? They pounded in our heads that you NEVER NEVER go distally--that once you've started a site, you keep moving towards the heart. I do trust what you're saying, but I'm just wondering why it seems that there's this broad continuum of ways to do things--why there is no consensus, so to speak.

I have a hunch that, based on what I've written, most people on this board think I'm this hostile, know-it-all, in your face type person...that couldn't be farther from the truth...I'm actually the opposite. I wasn't trying to hurt her feelings or humiliate her or anything like that. If I knowingly hurt someone's feelings, I feel just as badly, if not worse. I really dislike conflict, and try to avoid it at all costs. After I blurted out my comment (still not sure why I did it), she asked me how long ago I graduated and where I went to school. My mom then piped up that I had recently passed my boards...the nurse went on to say that some days you have good days, others not so good...I tried to rectify the situation by saying that I understood because there have been days where things didn't go so well for me, either. I wish things could have been different on both sides of the situation, but unfortunately what's done is done. At this point, all I can really do is learn from my mistake, and make sure it doesn't happen again unless it's really warranted.

~Lori

[buddiage]

I WILL NEVER ALLOW FAMILY TO CONTROL THE IV PROCESS (OR OTHER NECESSARY PROCEDURE) AGAIN. AND ANY COMMENTS THAT BRISTLE ME - WILL ASSURE THAT THE FAMILY CAN "OBSERVE" THE IV INSERTION FROM THE COMFORT OF THE WAITING ROOM.

Amen! I don't know how you restrained yourself...wow!

[Antikigirl, ASN, RN]

Been on both sides of this one, as have many!

I found a neat technique when dealing with family members in the hospital...get out of the room when things are being done! I am NOT their nurse and should allow for time between pt and nurse as part of the professional relationship. If I am in there, I will certainly be picky and proably make the RN nervous, pt nervous or anxious to see my responses to tasks they perform, and one wrong look and that will ruin the trust between the pt and nurse. Best if I just leave...and ask questions about how my family member felt afterwards. And now that I am a nurse...I really wish others would follow suit! LOL!

Another one, especially when I was in school and wanted to watch EVERYTHING I could...I introduced myself as a student nurse in a very down to earth and positive way (as not to look like an upstart...which frankly I was! LOL!), and asked if it would be okay for me to stay in the room, and if so ask questions. I always got a yes! If I saw something being done I wasn't sure about...I simply asked like for this situation... "So you can go below the old IV site...I didn't know that...how does that work?" That way I was getting info about that nurses rational for doing it that way...and maybe learn something about the 'real world' of nursing!

(I had a very healthy respect and realistic mindset between being a student nurse and being a nurse out of school because of excellent teachers and preceptors, and being married to a paramedic. I learned early on that things never go by the book, and all I knew was the book at that time because I was a beginner.).

What you had happen is commonplace with being a medic! We are picky and do tend to see things in a very critical light...I know I do! LOL! But unless my family member complains or a complication is involved...I typically leave the medicine to the professionals..and when I am family...I discount the nurse in me and become the family member in my own mind. Heck...I rarely get seen as anything but a nurse by friends/family as is uhggggg! So being family is refreshing and time for me to take a back seat for once! LOL!

[jmgrn65, RN]

It doesn't matter as long as it's in not the same vein?!? Now why didn't my instructors tell me THAT?!? They pounded in our heads that you NEVER NEVER go distally--that once you've started a site, you keep moving towards the heart. I do trust what you're saying, but I'm just wondering why it seems that there's this broad continuum of ways to do things--why there is no consensus, so to speak.

It is not always possible and feasible to go above the site, if a patient is getting stuck numerous times they run out of veins, lab/phelb use ac, hands are not really good because pt's don't like them they get in the way and are easily pulled out. Why is there a broad continum? Because medicine is not black and white people are individuals, everyone is different, all patients with the same dx will not present the same way. So there is going to be more than one way to do things. It is going to vary by institions, patients, nurses, doctors, instructors etc.

[LeahJet, ASN, RN]

I wasn't angry, just confused...

Sorry, I guess we got the wrong idea from all the angry fire faces and words like "seething".

silly us........