Guilt after shifts

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Lately I have been feeling major guilt after every shift that I work. I am new to my job, but not a new nurse. I so badly want to do well, and I don't want the other nurses to think poorly of me. Today, I had a patient who I started an iv on in her wrist, which worked well and was gotten on the first attempt. 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. She is elderly and now has a large hematoma from the vein blowing. I tried again on her other arm, and again did not get the vein but no hematoma. I feel so guilty about the bruising and have been ruminating on it for hours. Is it normal to feel this way with a new job? I feel like I'm letting my patients down and making a bad name for myself as a new employee.

Specializes in Infusion Nursing, Home Health Infusion.

You never want to not do the right thing because of your concern you can't place another cannula. Leave the functioing one in if the patient will allow it until you secure a new one . you did the right thing but just place a new one first.

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Specializes in Med-Tele; ED; ICU.
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

Little old people have fragile veins and often times have lousy clotting. Hematomas happen.

Do keep in mind, though, that when the vein blows, you can minimize the hematoma by holding firm, direct pressure over the site. I'll often use the meaty palm of my hand to apply pressure to the site and surrounding area.

I don't get upset about missing IVs... Joe Montana threw picks, Michael Jordan missed free throws, Tiger Woods missed gimme putts. It's not the failures that define you, it's your response to them.

~~~

Oh, and never, never, ever pull a good line before having established another one. That's the surest way to call the wrath of the venous gods down upon you. You're lucky that she didn't pick that moment to code ;-)

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Specializes in ER.
You never want to not do the right thing because of your concern you can't place another cannula. Leave the functioing one in if the patient will allow it until you secure a new one . you did the right thing but just place a new one first.

This is the answer. Never remove a good IV until you get a replacement. And sell the idea to the patient, especially if she has poor veins and few options for a good replacement. The honest discussion while reassessing the site mentioned above are all good. Sometimes the patient backs down and decides to just wait it out. Pain is extremely subjective. I've had few IVs in my life, but a couple of them were rather uncomfortable, but not intolerable, the whole time they were in.

If you are unsure of your technique, ask coworkers who seem to be consistently successful to watch you and critique your method. Or watch carefully and learn when others are starting them. I start about 10 IVs a day in the ER, and 24 years into this I'm still picking up new tricks for difficult starts.

You focused your guilt on IVs. Not being able to provide the care we want to give because of other failings in the system is unavoidable. Learn, improve, and grow where you can, but NEVER feel guilty for your best effort.

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Specializes in Tele, ICU, Staff Development.

Hope you feel the luv from your fellow nurses!

Like everyone said so well:

"I will try another spot but cannot remove this IV until you have another access"

and....when starting an IV on elderly patients, don't use a tourniquet- the pressure causes veins to blow. Best wishes.

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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

You did the right thing. You assessed the situation with the IV, tried a few interventions and these did not satisfy the patient, and at that point it absolutely is not wise to insist on using that IV.

I believe you have experienced the exact scenario I had in mind when I decided to go down a bit of a rabbit trail in my original reply - which I chose to share because I've found it a common scenario in my practice over the years (ED). The quotes I bolded above are exactly typical of what the nurse may hear in this situation. I've been asked to come and start IVs countless times where, when I arrive in the room, it is obvious that the RN who is newer to starting IVs is basically being given a hard time. All of this is the same general situation as what you experienced....patient is testing and/or exerting control. Which is OKAY and understandable - these are stressful situations for them. As you develop your IV skills and get your stride in this new position, increased confidence will come through and will likely make these situations far fewer. In the meantime, you have chalked up some good experience for next time. :nurse:

Blessings!

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Specializes in Pediatric Critical Care.
In the elderly you can also perform a bevel down cannulation to minimize bleeding and hematoma.

This can also be a useful technique when placing a PIV on a neonate. :yes:

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Specializes in Travel, Home Health, Med-Surg.

I would not worry about it, every nurse has had doubts and regrets about things done/not done. Just for future reference I would have assessed a little more thoroughly before removing the IV. What hurt exactly, if she just came back from CT what was done to the IV, if they used it, or even not, maybe it was not the IV itself (grabbed by tech, hit on gurney etc). If pt stated that nothing like that happened I would explain to the pt to problems that can occur with starting a new IV and tell the patient lets give it some time and see how it is later, if she continues to insist then I would use the smallest needle possible for that pt (what is the IV for: fluids, AB, just because, pt going home tomorrow etc). Everyone feels like you at times, just do the best you can and try to make it as easy on yourself as possible.

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Specializes in Urgent Care, Oncology.

I know exactly what you're going through. I start IVs, access ports and PICCs, and draw blood as a RN. If you look back a couple weeks, you'll see my post about IVs in older adults. It is tough, and it is definitely something that takes time and practice. This week I only missed one IV and one Veni, and both those individuals had awful, awful veins. One was so awful that I put in a referral for a port because we had to stick her 6 times, and that was only for a draw. The other I had to put a consult into nutrition and her doctor because she was so dehydrated from "drinking" Vitamin Water and soda all day. She had to be stuck 6 times as well. She was only blood thinners, too, which makes veins so fragile. I actually got into her arm and had a great IV on the first stick but advanced the catheter too quickly and it kinked, hitting the vein wall and blew. But - I learned something! It reminded me to go slow with these patients. I'd suggest reading that post if you get a chance. It does get better - I went from getting 5/7 to 8/8 or 9/10 in just a few weeks, so I'm getting faster and able to do more.

I'm like you, I like to dwell on things after they happen. I like to think that people look at me and are like "WTF VaccineQueen?" when in reality they didn't give the issue second thought and moved on. Really, just keep practicing. Watch what other people do and what works for them.

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I know exactly what you're going through. I start IVs, access ports and PICCs, and draw blood as a RN. If you look back a couple weeks, you'll see my post about IVs in older adults. It is tough, and it is definitely something that takes time and practice. This week I only missed one IV and one Veni, and both those individuals had awful, awful veins. One was so awful that I put in a referral for a port because we had to stick her 6 times, and that was only for a draw. The other I had to put a consult into nutrition and her doctor because she was so dehydrated from "drinking" Vitamin Water and soda all day. She had to be stuck 6 times as well. She was only blood thinners, too, which makes veins so fragile. I actually got into her arm and had a great IV on the first stick but advanced the catheter too quickly and it kinked, hitting the vein wall and blew. But - I learned something! It reminded me to go slow with these patients. I'd suggest reading that post if you get a chance. It does get better - I went from getting 5/7 to 8/8 or 9/10 in just a few weeks, so I'm getting faster and able to do more.

I'm like you, I like to dwell on things after they happen. I like to think that people look at me and are like "WTF VaccineQueen?" when in reality they didn't give the issue second thought and moved on. Really, just keep practicing. Watch what other people do and what works for them.

That's exactly how I feel- that others are judging what I do when in reality they probably don't really care. There is one older nurse in particular that works in my department that made a comment that I needed help "again ?" On a particular day but I felt it was unwarranted, because the first patient she offered to place an iv in before I had even attempted. She saw I was busy and then offered to take it off my plate.

The second time I attempted and failed, then asked for her help. I guess I know who not to go to now.

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The second time I attempted and failed, then asked for her help. I guess I know who not to go to now.

Au contraire! :)

[Assuming she is indeed an expert at what she does] - I have pursued these types nearly relentlessly when I've come across them in my career. They come across as being a little bit gruff, but it's a shell worth cracking in my personal experience. I have learned so very much from this type.

[if she's a grumbly run-of-the-mill non-expert, disregard the above. Observe and decide]

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Specializes in Urgent Care, Oncology.
That's exactly how I feel- that others are judging what I do when in reality they probably don't really care. There is one older nurse in particular that works in my department that made a comment that I needed help "again ?" On a particular day but I felt it was unwarranted, because the first patient she offered to place an iv in before I had even attempted. She saw I was busy and then offered to take it off my plate.

The second time I attempted and failed, then asked for her help. I guess I know who not to go to now.

I'm with you on that. People will talk, but probably not as much as you think. I'm one of those people who likes to think back to ten years ago when I said something or did something strange, and then I'll cringe and obsess over it. I've gotten much better about it as I get older, but sometimes things still get to me. I've also learned it is just better to ask people if they have an issue with me - not in a demanding way, but in a "hey, what's up?" type of way. I was a weird kid and still weird in high school, so I really didn't "bloom" until college on my own. I think some of my insecurities from actually being judged during those time periods carried over into my adult life. Just remember that while we went to nursing school, nursing is a very learn-as-you-go profession, and often others don't really care or think twice about what you're doing as long as you're not lazy, prompt, and most importantly - keeping your patients safe.

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First, YAY for the first IV. It probably was sore because when they push the contrast in CT, it can burn for some people and they have to push it fast, which is uncomfortable. From now on, I would ask the pt what happened with the IV since you last saw them and maybe refrain from removing good IV's until a new one is placed (just in case). The hematoma thing is super common, especially for the elderly or people on thinners. Sometimes holding pressure for a while helps as well as a pressure dressing; but other times, it's just unavoidable. Nothing to feel guilty about. You didn't stab someone, trying to make your mark. Could the guilty feelings be more likely anxiety of being the new employee? That's totally understandable. There are always a couple of bullies on the new playground - don't give them your mental energy. Just remember that you are probably your own worst critic. Give yourself credit for all the things you did RIGHT during your shift!

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