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.
I have read this whole thread and am just not getting it. We are talking about NS being 0.9% saline, right? As far as NS goes, we give it in the ER very fast sometimes, maybe 1000cc over 3-4 minutes with the rapid infuser in traumas. We routinely run in 1000cc bolus, wide open thru whatever sized needle we can get in.
As far as heparin, we run it with NS and NTG all the time. If fact, I have worked in several institutions over time where it is mandatory to have NS running as a "carrier" fluid then other meds piggy backed into it as a safety mechanism. As far as the roller clamp being on the heparin, wouldn't the pump beep occlusion?
The whole thing sounds fishy to me. If you did as you say you did, then you did nothing wrong as far as I can see. Before you let them railroad you and ruin your career, you need much more information, and do not let this go further without it.
Yes, the patient may need a central line, but it is not because of you.
. As far as the roller clamp being on the heparin, wouldn't the pump beep occlusion?
If a drug is piggybacked our pumps will not beep occlusion. They just pull from the open bag. My take on this, with the information provided, is that the problem wasn't the normal saline, it was the lack of heparin. But how this was presented to the OP was very confusing.
If a drug is piggybacked our pumps will not beep occlusion. They just pull from the open bag. My take on this, with the information provided, is that the problem wasn't the normal saline, it was the lack of heparin. But how this was presented to the OP was very confusing.
Maybe that is why we use a separate channel for each drip where I work. No chance of what you mention can happen using this philosophy. Yes, we are definately lacking the whole story. It makes it hard to make a determination as to what really happened, we are only speculating.
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
First:
What does your hospital policy and procedure say about infusion of heparin gtts??
That would be my first place to compare what I had done against what maybe should or should not have happened....
Then, I would definitely defend my position....and ask for the DON to give to me in writing the complaint against me....
(this does two things: it shows her that you are not a push over....that you are not going to take something laying down, and you are clearly 'taking charge' of your situation...ie, not a victim) When you ask for something in writing from your DON you are setting a precedent that says, "I expect and demand professional treatment", and you are forcing them to establish their complaint in writing....once this happens in writing, it places them in a more equal playing field with you LEGALLY, because once they write something down, it is admissable in litigious situations....
secondly:
NORMAL SALINE IS 0.9% sodium chloride.....last time I checked, that is the exact same solute/solution ratio found in HUMAN BLOOD...so is the ocean....but that's another story....sooooo for the DON to make a verbal claim that NS would be caustic to a human venous system is absolute poppycock! She needs a chemistry class and a refresher course on common drugs that cause extravasational problems....
Heparin isn't one of those drugs....if that were the case, then we could not inject heparin subcutaneously....duh!
Heparin can cause antibody resistant problems...ie thrombocytopenia...and some people develope abnormal PTT ratios because of ethnicity....(some Asian ethnic groups are very difficult to target anticoagulation because of genetic differences....for some reason they tend to get INR ranges that are critically high with the same dosing schedule as caucasian and other groups....weird...but I have seen it happen...)
Tell your DON that you are respectfully requesting a concise critique of all that she found "wrong".....tell her you are unable to respond to her statements, because they are truly not clear to you, and that you would like to be able to address whatever it is that she is alluding to, but that you need more information, and clear information.
Tell her it would be extremely helpful if she could write it down, itemize it if you will, so that you can direct and focus your attention to whatever it is that she found lacking....
Also, request that she include any and all IV therapy protocols being used within her facility that directly addressing proper infusion of heparin....different places have different ways of doing things....and are not necessarily unsafe, or wrong, or not correct....
they just have different ways of doing a heparin gtt.....
Often, some places encourage a "back up" normal saline at tko to enable the vein to remain open, or to dilute the direct amount of the drug hitting the vein wall....this in NO WAY changes the dose the patient receives....it is basically a normal saline "bath" that keeps the vein from becoming irritated by the infusion.....but heparin typically doesn't cause venous irritation....and neither does normal saline as stated earlier....
Your DON seems over-reactive....maybe she doesn't have all the facts, or maybe she is being fed wrong information....
nevertheless, you can't address professionally what you don't have all the facts on yourself....it's time you respectfully ask her to write it out for you....
I agree with all of the above and would add; don't go in by yourself, but don't race for an attorney quite yet; it would be great if there was an advanced practice nurse who could go in with you so this could be an educational meeting for you and the DON.
It is good you admitted to the fault but you would have explained what you did immediately too. in the future, you should ask about drug administration if you have even the slightest doubt that you might be wrong. or just ask to be certain before administering medication. it is not a crime because we need guidance always. luckily it was not fatal
A similar thing happened to my classmate and she was cautioned and allowed to continue the program. am a 3rd yr nursing student. be careful all the time. goodluck.
I programmed NS as primary at 30cc/hr , VTI 30cc, and hepain as a secondary 32cc/hr, VTI 500cc.
Hi,
You'll have to excuse me, I'm an australian rn, and not sure of the abbreviations but...if NS is normal saline. how could you ruin the patients vein?
secondly, the ward you are on should have a manual of policies, which tells you how to do certain things, eg. heparin infusions. I know at my hospital, you'd need another RN to check what you are doing. You seem to have been left high and drive and that's poor on their behalf.
Please post as to how you go. You will be feeling bad but we've ALL made mistakes. Hang in there
As a nusing student we are always supervised by an RN, so if that is done, so many mistakes can be avoided. also we must learn to ask when not sure...thanks for your post and encouragement.
i believe that the first thing that you need to do is obtain and read the hospital policy/protocol for heparin administration.
if you can determine from the policy that you indeed violated it by your action or inaction, you must take the write-up like the professional that you are.
if it is determined that policy wasn't violated, when asked to sign the write-up document refuse to sign it and ask for a copy of the document, if you intend to seek legal representation, to give to your attorney.
if an attorney isn't in the cards, write your reasons for refusing to sign it somewhere on the document and return it to the manager of the unit. that way your side of the story is available for anyone examining your employee file to see and understand your side of the situation. this will come in handy if you transfer to another area of practice within your facility.
start the written refusal to sign with something like this;
i, [insert name here], refuse to sign this document. then proceed with your version of events.
i hope this gives you some clues as to how to handle the situation.
it is good nursing practice when performing a proceedure or task for the first time to determine if there is a protocol that must be followed and/or a hospital policy that one must adhere to.
ask your fellow staff members. if you don't feel comfortable with their advice, look up the policy yourself and read it.
if you still don't feel comfortable, call the covering house supervisor for further advice on the situation.
often times nurses in the specialty areas [ed, or, icu, ccu...] can be helpful in certain situations, use all available resources when not sure when performing a proceedure for the first time.
keep your chin up.
the only nurse that doesn't make a mistake is one who doesn't report their mistakes and/or hasn't been caught making a mistake by a staff member who would report it to those in authority.
Specializes in ICU of all kinds, CVICU, Cath Lab, ER..
Are they writing you up, or just calling you up and making STUPID statements? This is the dumbest thing I have ever heard!!
A central line is always the preferred access in an icu setting but if you have to go peripheral since they won't give the patient a central line, it is acceptable to run Heparin with NS..... you know the rest of the story....
Ask for a meeting within the chain of command.....keep us posted!
What happened to the DIKH (Did I Kill Her) rule? Digoxin, Insulin, Potassium (K+), and Heparin. You check with another RN when you administer, every time. Sounds like the mistake could have been caught but I agree its too late for blame, just learning. I am sorry to hear your employer is leaving you freaked out instead of using this an example in an update/inservice etc. I also agree with others...how can NS ruin a vein, particularly at such a low infusion rate?
If I were you, at this point I would get all my info in order: find your facility's policy on heparin administration and also review heparin drip in your nursing texts/notes and make sure you are covered since they are going through with an investigation.
What I appreciate about a mistake (provided they arent fatally harmful) is that you would probably never make a mistake with heparin drips again after this, and therefore be a better nurse. I hope your employers realize this.
Dixielee, BSN, RN
1,222 Posts
I have read this whole thread and am just not getting it. We are talking about NS being 0.9% saline, right? As far as NS goes, we give it in the ER very fast sometimes, maybe 1000cc over 3-4 minutes with the rapid infuser in traumas. We routinely run in 1000cc bolus, wide open thru whatever sized needle we can get in.
As far as heparin, we run it with NS and NTG all the time. If fact, I have worked in several institutions over time where it is mandatory to have NS running as a "carrier" fluid then other meds piggy backed into it as a safety mechanism. As far as the roller clamp being on the heparin, wouldn't the pump beep occlusion?
The whole thing sounds fishy to me. If you did as you say you did, then you did nothing wrong as far as I can see. Before you let them railroad you and ruin your career, you need much more information, and do not let this go further without it.
Yes, the patient may need a central line, but it is not because of you.