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.
Specializes in cardiac/critical care/ informatics.
something is not right, just because the ns went in and heparin did not. That would not ruin a vein. I don't understand what her problem is, maybe there was an error in your part but not enough for all of the investigating.
Get a copy of your write up and see if there is someone to represent you, does your facility have anything like that?
If anything you should be counseled for piggybacking the heparin instead of running it as a concurrent line, but that's it and even that's a stretch. That is strictly an education point, nothing else.
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!
I'm trying to figure out why they'd be so bent out of shape over this...
Was the doc planning on placing a new graft in that arm? Did the IV infiltrate? Where is the permcath?
I think you need to get this clarified. The explanation you were given that NS 'ruined' the vein just doesn't make any sense.
I work on a renal floor. Most of these people have 22's in. For the heparin/saline thing. Most of the time we only have one access. I always program two pumps. I have seen it with one, but that isn't safe in my opinion. Both primary and then hook up the saline to the pt. as main and then put the heparin in the port next to the pt. The heparin don't burn and I have never had it infiltrate. IV's infiltrate that is a fact. But the way this sounds it is crazy to have a write up about it. If the pt. was getting labs off of the foot, then a picc or a central line needed to be in when they got admitted. Keep us posted. This in one of the reason's I got myself covered when I started nursing. Good Luck! If you don't know anything always ask!
The only way this is making any sense at all to me is if the OP failed to open the roller clamp to the piggybacked heparin, causing the NS to go in but not the heparin? At that slow rate, the vein would've been "ruined" because it would've clotted off, as well as the patient not getting the heparin.
Even so, I agree; there's no way that either of the fluids ruined the vein, especially at the rates given, and I'm just confused at this point about the real problem.
Did you see any puffiness, redness, bleeding or leaking around the site? Did the patient c/o pain at the site? Or did the vein clot off because the heparin failed to run?
OK there is something that is really fishy about this situation and how your DON is handling this.
I'd say you are DEFINITELY being made a scapegoat for some pretty severe systems deficiencies going on here.
When policies are not in place that define what needs to happen that is a system error. Do you have a Heparin protocol? Did you follow it? Did your orientation include the Heparin protocol? IF not that is also a system error. Can you get your hands on the Heparin protocol at your facility before you see a lawyer?
I am so sorry you are going through this. It is never easy dealing with our own errors. The only things I can see that you did wrong was piggy backing the heparin (but as long as your pump was set at concurrent, that should have been OK, do you think that was part of the problem, that the heparin just didn't get restarted when you changed the dose, for some reason?) and not having someone double check the pump with you--not just the calculation, but come in and check the pump.
OK we all make errors, please forgive yourself and find a new job anyway. What a crappy environment to work in!!!
It sounds as though they are not telling the whole story...
What are they afraid of? NS does not harm a vein. IV's infiltrate or get clotted all the time, no big deal. The worst thing could be that the pt didn't receive the proper dose of heparin but evidently that wasn't the issue. Even if it was...it is not a criminal mistake. The patient is doing fine. Sounds like they are hiding a bigger issue. Good Luck.
OP, I could see making this a med error issue, if the ordered dose of heparin didn't get administered. But "ruining a patient's vein"??? With normal saline, at that slow rate??? Even that phrasing seems off -- it isn't terminology used by medical professionals.
I think you're getting hosed. Don't be defensive, ask for the facts, review the chart, ask specifically what you're being written up for, ask if there is any action re: the nurse who co-signed the heparin with you, and don't be intimidated.
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jmgrn65, RN
1,344 Posts
something is not right, just because the ns went in and heparin did not. That would not ruin a vein. I don't understand what her problem is, maybe there was an error in your part but not enough for all of the investigating.
Get a copy of your write up and see if there is someone to represent you, does your facility have anything like that?