Oxygen levels possibly hurt pt?!

  1. I was switching my patients nasal cannula over to a nonmask rebreather with a PCA tech. The pt must be on oxygen at all times so I had someone help me. When the PCA switched patient over from nasal cannula to nonmask rebreather I somehow accidently plugged in the wrong O2...Somehow I replugged the nasal cannula tube back into the air supply. After a few seconds I noticed the nonmask rebreather was not inflating with oxygen so I quickly saw my mistake and switched the tube quickly back to the nonmask rebreather. Pt. oxygen went from 85 to 60(when we were switching his oxygen) back up to 88-90. (pt. was on 15L nonmask rebreather and 12L nasal cannula)

    I feel really bad that I caused his oxygen level to get that low due to my mistake in plugging in the wrong tube. After that mistake pt was fine, he was laughing, joking around, no problems. About 36hrs later, I found out patient had passed away. Could I have caused a problem? I am a nursing student and I feel awful. Since his death I think about everything I did that day from "did I hang the correct IVPB", "did this O2 level cause something bad to happen", he also had gotten insulin (BS 298) and he ended up not eating his lunch except for a few peaches so I think "what if I bottomed pt. out and he went into a coma...." I always think worse case scenario. I keep talking about it and I try to figure out my day and what I did and I keep blaming myself for his death because I feel like I had a horrible day at clinical.

    I don't want to contact my instructer again about it because I think she'll think I'm crazy. I talked to her and she said "you did nothing to cause this man's death." Though she doesn't know about the O2 instance. My thoughts are becoming very obssessive, and I cry about it. Can someone give me some advice on how to deal? What do you think about my scenario?
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    About samiam4

    Joined: Oct '11; Posts: 30; Likes: 5


  3. by   kool-aide, RN
    Things like this happen. If you caught your mistake after a couple of seconds, I'm sure this mistake did not cause the pt's death--however, if you had left the pt that way for an hour, that may very well have been it.

    Pts die, if this is still bothering you several days after the fact and you're still obsessing about it, you should seek a counselor to speak with.
  4. by   DookieMeisterRN
    Honey chances are since this pt's O2 needs were so high, he had one foot in the grave before you ever touched him. I know you feel at fault possibly but know that he eventually would have passed and if his O2 sat plummeted that quickly he was very, very sick.
    Last edit by DookieMeisterRN on Feb 20, '12
  5. by   DixieRedHead
    I really doubt that a couple of seconds made any difference. O2 at that level is a harbinger of death. He must have been really sick.
  6. by   samiam4
    In report that morning the primary nurse told me he desat's into the 60's overnight...He had pnuemonia, CHF, type 2 diabetes, pulmonary hypertension just to name a few things... Even if he was really sick I don't want to be the one to make him sicker you know? So the whole situation just makes me anxious and drives me crazy thinking about what I should have and shouldn't have done etc....
  7. by   RTsoonRN
    You did the right thing catching it when you did. Take it from an RT in school, I've seen these pts many times, they are fast crashers and slow crawlers (fast to desat and slow, sometimes painfully so, to crawl back up). He/She Han too many comorbidities to have you be the cause of his death. Take it from the seasoned ladies on this forum...he was already going.
  8. by   tokmom
    No, you did not. I will echo what the others said. This guy was really, really sick. He didn't die 5 min later, or even on your shift. He died a full day/hours later.
  9. by   samiam4
    Thank you all for the comments. The more you all comment about the situation the better I'm feeling!
  10. by   NeoPediRN
    SamIAm, no, you had nothing to do with his death. If he had that high oxygen requirements then his sats probably drop into the 60s regularly just from moving around once there is strain on his heart. Being on 100% O2 is toxic, he was very clearly decompensating with his need for increased O2. Listen to me one more time. YOU had NOTHING to do with his death. As you get more experience you will look back on this and realize that. For right now, you'll just have to trust us. Patients die, we don't like seeing it but it happens often. If you start carrying the burden of every patient who passes that you've cared for you are not going to be able to last in this field. We all do the best we can for our patients and that is ALL we can do. Despite our best efforts, chronically ill patients will continue to decline and pass away. At the end of your shift you need to be able to reflect and then put it behind you. There's lots of joy to experience in this field, but you'll miss it if you're preoccupied with beating yourself up over things you cannot control.
  11. by   AICU RN
    I posted something similar about a patient of mine a few weeks ago. She was my first patient to code (on my shift) and she later died (though not on my shift). I went over the entire day in my head repeatedly trying to figure out what I did wrong. I was absolutely sure that something I had done that day had led to my patient's demise. I mean, how could it not? One minute she's laughing and talking to me and the next we're pounding on her chest frantically fighting for her life.

    Then I thought about it. I talked to my friends. I jumped on this board and asked experienced nurses for their thoughts. You know what? My patient was sick too. She may not have seemed like it in 11 out of the 12 hours I was lucky enough to spend with her, but she was sick. She was diabetic and hypertensive and had a huge cardiac history.

    Someone from that post had told me that certain patient's come into our lives for a reason. I know I will never forget that patient, that day, or that feeling that I may have even remotely been responsible for my patient's death. I knew I never wanted to have that feeling again. It has made me even more aware of everything I do and even more thankful for each moment I get to spend with each of my patients.

    Anyway, these situations happen sometimes and in short, we need to learn to deal with them. It's not always easy, we bond with patients everday and that's not a bad thing. It can be ridiculously hard to deal with the fact that we don't always get to win but it's just the way it is. It's great to have a support system (even out of this message board). I have friends that are nurses and I think talking to people who can relate is important. It's just as important to find a hobby that can help you get away from the hospital or other healthcare setting.

    Good luck and I think you'll be a wonderful nurse .
  12. by   MyUserName,RN
    No you did not cause his death. I know how you feel though. A few weeks ago I had been taking care of this same pt for 3 nights in a row, the first two nights she did fine on 3L nc, the 3rd night she was on her home CPAP. While cleaning her up with the tech and rolling her around she started having trouble breathing, desated and then we believe she siezed or had a stroke, had to call the rapid response team and sent her to the ICU where they were talking about intubating her. I never did find out what the outcome was. I thought about this situation for a week non-stop. Running through the whole night and wondering if I had done something wrong. Feeling guilty that us rolling her around to clean her up maybe caused it, but you can't leave a pt soiled, and if a pt is that sick that they can't tolerate rolling onto their side, they are already very sick and it's nothing anyone caused. After talking about the situation over with other nurses I felt better and know that I didn't do anything to cause her distress.
  13. by   samiam4
    Wow, thank you so much for that post AICU RN. It's really nice to know that I'm not alone with this whole situation. I really really appreciate it. This nursing board gives me the strength to carry on with nursing because frankly there are many times I just want to throw my hands up and quit, especially after this episode. I'm so very thankful for you all to take the time to comment about my situation. It really helps!
  14. by   samiam4
    Thanks for sharing your story MyUserName, RN. It feels good to know we can all lean on one another during a tragic event. Even if it's just sharing similar stories. It really does make me feel less alone.. Thank you