Last night I accesed a port with a 20 g Huber needle, I had excellent blood return and it flushed great and I connected her IVF's. Well, 5 minutes later it was occluded. I was in another patients room so my CN went in to assess it. The CN noticed that the tubing had blue material in it, it was brought to the patient's attention. Of course "she couldnt see anything". The CN came to get me so I could go take a look at it and remove it. When I entered the room, the patient had already rushed and removed the needle herself and placed it in the sharps container before I could see it. She said that the CN told her to remove it! Now pleeeeaaaaaase, come up with something better than that! Now, I had admin Percocet just 5 minutes prior to all this transpiring. She had crushed that percocet and pushed it in her port! (she used to be a nurse, but her license had been suspended. Im suspecting drug abuse). She HAD to dig a flush out of the trash to do this with. Well, we pulled that needle out of the sharps container along with the previous one. Both had dried material in them. We saved them to show the physician on rounds this morning. But I left before they hit the floor. All night long, I was pushing Dilaudid and Phenergan. Finally I made her NPO. I told her that if she is that sick, then she doesnt need to be eating. (her admission was abd pain and n/v). The physician knows, he had written an order previously in all caps and LARGE print..."NO IV NARCOTICS", but then changed it the next day. I felt like a legal drug pusher last night. Then I had a cancer patient who was in miserable pain, with minimal pain control meds. I hate my job!
I had a homeless patient once who had a history of IVDU (and injecting things into himself to make himself septic and come to the hospital for shelter I suppose?)
Anyway... He was getting Oxycodone 5mg PO around the clock, along with multiple IV antibiotics and a slew of other meds through a Left Jugular triple lumen CVC....
The dayshift nurse and I (on nights) both watched him take his narcs, drink plenty of water.. and we would talk to him for a while afterwards. We figured if he was speaking clearly, and it didn't sound like he had pills in his mouth, that it was safe to assume that he had swallowed them.
Well we were wrong... lesson learned.
At 2 am he became tachycardic, short of breath, diaphoretic (it looked like someone dumped a bucket of water on him) and he had severe tremors. Not to mention the 102 something fever he had going on too by then.... I called his attending (still unaware of what he had done), got him some lopressor, xopenex, motrin, etc... A half hour later all of his symptoms got much worse and his bp was 60/30.
I transferred him to ICU, where upon arrival we all noticed orange residue on the tip of his CVC... another nurse went through his belongings and found an unmarked syringe from outside the hospital, also with orange gunk in it. (his oxycodone was of course, orange.)
Naturally, the patient denied everything...
They had him on every pressor they could think of... nothing worked.
At 5 am he coded and died.
Unsure of the autopsy results as to the exact effect the pills had on his body, i'm assuming multiple pill-emboli in his lungs? It was a horrifying experience, needless to say... (yeah I went down for the code... first time i saw a pericardiocentesis... s/p?)
The next day the psych liason came to visit to make sure the nurses involved were doing ok and coping with the incident... sigh...
:chair:
... we've also had patients snort their oxycontin (after doing another sneaky cheeking job, we found a pile of crushed pills and a bent butter knife in his room! lol! ... i know it's not funny, but come on! you don't leave evidence like that!) and now we have another patient whom we suspect might be injecting PO meds through his PICC... Probably vomiting them back up as a previous poster suggested.
Now we are crushing them and giving administering with applesauce! :chuckle
chenoaspirit, ASN, RN
1,010 Posts
Dx was "abdominal pain, n/v, dehydration". They have done every test possible, AAS, Scopes, cysto, u/s, etc. They cant find anything wrong with her.