heparin drip mistake! what would you do?

[youngever]

I am in my first year of nursing. Although I still make a little mistakes from time to time,I thought I was getting better until I received a phone call from my DON last Friday that I messed up pt's vein by piggybagging heprin drip with NS. She said that pt needs Central line because of my mistake.

I programmed NS as primary at 30cc/hr , VTI 30cc, and hepain as a secondary 32cc/hr, VTI 500cc.

I did not know that I was supposed hang heparin by itself.

According to my DON, pt received NS instead heparin which ruined his vein.

I did not know what to think of and I apologized to her that I made a mistake not knowing to hang heparin by itself.

She told me that the incident is so severe that I either would be written up or suspended after investigation is completed.

She left a message not to come back to work until I hear from her.

I have not heard from her today.

Although I apologized to her( at the time, I did not explained her what I did except admitting the fact that I piggybagged the med. However, I really don't understand why the pt received NS instead heparin. Heprin was hung much higher than NS.

Pt is in ESRD with very fragile vein that Lab had to be drawn from his foot from the begin with. One of my coworker told me that lovenox is replaced to heparin drip. pt is doing fine. Would you give me some insight and how to resolve this problem? Any suggestion would be appreciated.

[TazziRN, RN]

I'm sorry....NS to run at 30/hr and hep at 32/hr......and NS running in that slowly ruined his vein? I don't think so!!

I have run hep in with NS through periph lines many many times. Centrals are desired but not necessary.

You hung it as a secondary.....you mean as a piggyback? That you are not supposed to do, it should be a concurrent line with the connection as proximal to the pt as possible.

But the NS running at 30/hr ruining his vein? I don't think so!!!

[melissasrn]

First of all, I don't understand how NS can ruin a patient's vein in the first place. Maybe I read this wrong though.

As a new nurse, do you have someone more experienced you can't turn to for questions when needed? For example, our nurses are required to have another nurse witness the dosing of Heparin drips. Perhaps if this were a policy at your facility, the piggybacking error may have been caught ahead of time. Thankfully, we rarely use Heparin anymore as Lovenox is SO much safer and easier to administer.

Of course you cannot go back and "fix" the error now, but I do hope the patient comes through okay. Good luck and I hope you don't lose your job over an honest although "severe" mistake according to your DON.

[cheshirecat]

I have never heard of NS ruining someones vein. The only thing I can think of is that the IV had already infiltrated the vein prior to you adminisitrating your meds/IV.

It sounds as if she has poor veins, and they are using you as a scapegoat.

I would get professional advice.

[kmoonshine, RN]

"I programmed NS as primary at 30cc/hr , VTI 30cc, and hepain as a secondary 32cc/hr, VTI 500cc."

On our pumps, if you are running both a primary and secondary, the secondary kicks in first and once the VTI is complete, then the primary kicks in. In this case, it would take 16 hours for the heparin to infuse before the NS would start infusing.

Anyways, this patient should have had a central line placed long ago. Drawing labs from a foot, but calling you out because you "ruined a vein with NS"? The fact that they had to draw labs from the foot warrants a central line. Besides, with medications like heparin, it is my opinion that the patient should have 2 PIV's; that way, if there's a problem, you have another site for access. IMHO, they are making a big deal out of nothing! The patient was not over-coagulated, and his IV site probably clotted off or the vein blew. If the patient had a 22g or 24g IV, that tells you that they probably have poor veins (I mainly use 18g, sometimes 20g, rarely 22g, and I never have used a 24g). Regardless, many ESRD patients are very, VERY hard sticks and if 2 reliable PIV sites can't be placed, then a central line/PICC line should be placed. Did this patient have an AV fistula or dialysis catheter? Don't EVER access these, but an AV fistula limits only one arm for IV placement, obviously.

You could have run NS and heparin together on two seperate pumps, both as primary. Hook the NS to the PIV site and then hook the heparin to the NS IV tubing port closest to the patient. This way, they won't get a heparin bolus.

I always have another RN double-check meds that have a high potential for injury, such as heparin. I also program the VTI much less than what's actually in the bag; for example, I probably would have programmed the pump as 32ml/hr, VTI=64ml. This would mean the patient would receive 2 hours of heparin, then the pump would beep/stop. Patients on high-alert meds need to be evaluated frequently to prevent sentinel events, and programming pumps for appropriate time frames helps to prevent pump programming errors ( I have seriously had a medication volume of 250ml, and the rate of infusion was 1.5ml/hr...which equals 166 hours:lol2:).

The patient didn't need a central line because you made a mistake; they needed a central line because they had poor venous access. Learn from this experience and move on. And remember to have another RN verify high-alert meds and be sure to chart the name of the nurse who verified the medication, dose, rate, and pump settings.

[P_RN, ADN, RN]

I don't see a heparin error here assuming that the heparin was given at the ordered dose. What was the concentration of the heparin and what was the ordered dose?

Was the saline ordered or did you chose it so you could kvo once the heparin went in? In no way you ruined the vein. I think you are being scapegoated big time.

[bill4745, RN]

1. NSS and heparin at a total of 62 cc/hour should not ruin a vein. If the pts' veins were that fragile, a central line should have been placed.

2. The facility should have a written policy that 2 RNs check "high risk" medications. If not, you should make it your own policy.

3. Anywhere that I have worked, heparin can be run with saline. ARe you sure you set the pump to run "concurrently" rather than "pggyback"?

[nyapa, RN]

As a new nurse, do you have someone more experienced you can't turn to for questions when needed? For example, our nurses are required to have another nurse witness the dosing of Heparin drips.

Do you not have a second nurse to double check anything given IV?

[youngever]

Thank you soooo... much for your replies.

Heparin dose was 26 cc/hr at the beginning, it was increased to 32 cc/hr based on next ptt. I have another RN to check the calculation and signed.

I piggybagged the heparin as a secondary with NS. DON said that the heparin did not go in, instead the NS went in and ruined pt's vein.

pt's fistula was clogged prior to admission and that was a part of reason him being in the hospital. He has a perm cath for dialysis.

pt is doing fine according to my coworker.

By the way, DON said that HR is investigating. I don't know how much there is to investigate when pt is doing well.

So, if I am being used as scapegoat, where do I go get an advice before hiring a lawyer. Is there a place inside of my hospital that determine the situation fairly? I really appreciate again for your supports. guys!

[BBFRN, BSN, PhD]

Was the IV in the same arm as the fistula?

[youngever]

No, Mam!

IV was in opposite side hand to AV fistula.

[BBFRN, BSN, PhD]

I would ask to see their written policy on Heparin administration. Start questioning them, and they may back off of you. It does sound like you're being scape-goated for some reason. Don't let them get away with it.