Guilt after shifts

quazar · Jun 22, 2017

Yeah, it's normal to feel upset about missing an IV. Don't stress though, you get some you miss some. Even super experienced nurses blow IVs sometimes. It happens. I limit myself to a 2 stick maximum and if I can't get someone on the first stick and don't see a really good viable option for the 2nd, I gracefully bow out and call in backup. You'll get there. You're not letting your patients down and you're not a bad employee, promise.

nrsang97, BSN, RN · Jun 22, 2017

Stop beating yourself up. It happens to the best of us. I am often paged and asked to start IV's, and do not always get them on the first try and sometimes I do not get them at all.

Pedsnurse1026 · Jun 22, 2017

I know I can't get every IV, but sometimes it feels like that is expected of me in this job. I have been needing help on 1-2 IVs per day and on an average have 6 patients per day.

In this particular circumstance, it wasn't missing the iv that has me so bummed but rather the large hematoma I caused. It was very big, unfortunately, and is going to cause an unsightly bruise

meanmaryjean, DNP, RN · Jun 22, 2017

I know I can't get every IV, but sometimes it feels like that is expected of me in this job. I have been needing help on 1-2 IVs per day and on an average have 6 patients per day.
In this particular circumstance, it wasn't missing the iv that has me so bummed but rather the large hematoma I caused. It was very big, unfortunately, and is going to cause an unsightly bruise

Hematoma is a known complication of IV attempts, esp. in the elderly. If anyone 'caused' it it was the patient who insisted you remove a perfectly functional IV.

cleback · Jun 23, 2017

If that is the extent of any harm you cause a patient, you can count yourself as very fortunate.

I have streaks of iv success. I can go for a long time without missing and then I won't be able to get one in at all, even if all my patients look like professional body builders wit bulging veins. It happens.

JKL33 · Jun 23, 2017

She went to Ct and when she came back, she insisted that I remove the iv due to pain. It looked fine and flushed well, but I removed it. She wanted it in her hand, and I tried, but the vein blew.

I'm going to comment on a little bit different track. I don't know how experienced you are as a nurse, but from your OP it seems that you are feeling very unsure in this new situation. I'd like to kindly recommend that while you continue to work on whatever skills may be new to you, you also allow yourself to develop confidence as appropriate; give yourself some grace. You don't deserve to be spending so much mental energy the way you are spending it (guilt, worry, likely being hypercritical of yourself, etc).

The right amount of self-confidence would've helped with this situation: If you can verify that it is a perfectly functional IV then you don't remove it...at least without having a pleasant but instructive comment with the patient about your assessment of the situation: "I'm sorry that's uncomfortable, I'll be happy to take a look at it. [flush, blood return, examine, etc] Well, it seems to be working perfectly and it is in the vein just where I need it to be. [flush again and offer "something" - ice pack, pillow to rest the hand on, etc]. Shall we try this for a few minutes before we make a decision? I'm concerned about removing it because I know it's no fun to be poked and it's not always simple to get another one." I might even remove the dressing and reposition it and place a new dressing, and say "There! I think that will help!" :sneaky: Happily (or sadly, depending on how you look at it) these interventions work ? more than 90% of the time IME.

Going a little off-topic with another tip: Perhaps not in this situation, but it's not uncommon for patients to use this exact scenario as a way to exert control for whatever reason. So maybe that site was bothersome and maybe it really wasn't. Either way, a good assessment and projecting confidence tends to help with the "I want my IV here not there" situation.

I personally wouldn't waste one second feeling badly about a hematoma that occurred in this context.

iluvivt, BSN, RN · Jun 23, 2017

Pain is a perfectly good reason to remove an IV. The volar wrist is known to be a very sensitive area and the radial nerve runs above the thumb and becomes superficial about 7cm above the wrist. The cannula sitting perfectly in the vein near it can cause cause discomfort. The second you notice that you have made a hole in the vein and cannot save the cannulation attempt.. Immediately pop the tourniquet and apply pressure...until the bleeding stops. In the elderly with fragile veins and if anticoagulated you need to apply a lose touniquet or none at all. Sometimes I just use my other hand to trap some blood in a vein or have a other nurse apply a hand tourniquet. In the elderly you can also perform a bevel down cannulation to minimize bleeding and hematoma. In terms of quilt...you did nothing wrong so no need to feel this way. What is the worse thing that could happen to the patient in the case Just an ugly bruise. You did the right thing by removing an IV that was symptomatic.... You did the right thing... A very long practicing IV specialist

JKL33 · Jun 23, 2017

Yes, iluvivt, pain is a reason to remove an IV. And I agree that the medial wrist (cephalic vein/radial nerve area) as well as the volar wrist can be problematic. But I stand by my advice to assess carefully and attempt measures to ameliorate pain prior to removing a functional and recently-new IV. You say the worst that can happen in this case is the hematoma. Well, that, and you no longer have a functioning IV. With your years of experience it may be easy for you to accurately assess the situation and decide to place a different IV, but this case itself illustrates my concern - there was a functioning IV, then there wasn't, and the OP ran into trouble trying to place a new one. Depending on the patient's acuity that could be a minor problem or a major one.

Pedsnurse1026 · Jun 23, 2017

In this instance, she was pre-op and did have other available veins, but insisted that the iv go into her hand. I guess I should have told her that I couldn't? I mentioned to her that the veins in her hand were small and fragile and would be unlikely to hold the size we needed. She just said that nobody's had trouble before- she had never had surgery- only blood draws in the past. But the non medical set typically doesn't distinguish between the 22 butterfly and 18 gauge I suppose.

I was trying to appease someone who I believe was trying to exert some control in the situation.

And yes this is a new job for me, typically in my previous position we rarely inserted IVs

Pedsnurse1026 · Jun 23, 2017

Also I did offer to redress the iv and I flushed it as well. She was very persistent that she wanted it moved so I did as I was asked. However, my coworker who came to put in the new iv did say something that was sort of a "duh" moment with me, to not remove the old working one before placing my new iv. Seems obvious now, but should have done that.

iluvivt, BSN, RN · Jun 23, 2017

And how to you plan to relieve that pain because it sounds like nerve pain and there is not much to do in that case but take it out. In addition you cannot ignore a patients demand to remove a cannula. If they do demand it and you cannot place another then I suggest you carefully document that and use your resources. Get someone else that is better at placing IVS.