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.
All good nurses make mistakes. Great nurses never make the same mistake twice. Ask for a clear explanation of the error you made and how you should have performed. Once you fully understand it and know with certainty that you can do it correctly, FORGIVE YOURSELF!
First of all, Normal Saline does not ruin the veins. Heparin hung as a piggyback is not a dangerous thing. Its just not therapeutic. I can't believe your DON made such an issue about this. That is crazy. Man she would have a cow, a horse and a goat if she worked at our hospital. This really does not make any sense at all. The patient probably needed a central line because of no veins. But you are certainly not the cause........TRUST ME.
I'd like to add a little input here. Maybe I'm just reading a little too much into it but as everyone else has said here, NS will just not ruin a vein. The only thing I can imagine is that the (clogged?)AVF was being kept patent with the heparin, and with the NS running instead of the heparin, it clogged up. Is it possible that the AVF was the "vein" that was "ruined" and not the actual vein with the PIV? I would think that ruining a patient's AVF, especially one with poor veins, would cause plenty of people to be upset.
I haven't posted very often at the site, but this made me have to chime in with my opinion and thoughts after 25 years of being a nurse. So many things sound to have been done wrong here.
Many have been pointed out already. Normal saline does NOT ruin a vein. The patient had poor venous access to begin with. I work at a transplant teaching facility and this patient would have had a PICC line a long time ago as would be appropriate or a central line. Secondly all nurses make medication errors. We hate it and try to prevent them, but we make mistakes. We shouldn't eat our young (this young nurse) and try to beat her over the head for the error. Give her the education and counselling to prevent a future mistake. You don't suspend her.
Fix the problem! Inservice!
If it helps at all the first bad error I made was with heparin. It was to be increased because of the patient's PTT and I calculated the rate innappropriately. Luckily it was found and there was no harm to the patient, it just took longer to reach the therapeutic level. I was a young nurse then too. You never forget. It was 20 years ago at least. It was before Heparin was double checked with another nurse and now heparin is usually a standardized concentration. A drip rating list should be posted in the medication room.
They need to counsel you and give you something to read and sign if they are suspending you. This is several days old. I hope it has been resolved for you by now. I'm so sorry you've gone through this. No wonder the average age of an RN is 46.1 (ha, I know it's down from 46.7). We drive nurses away instead of making them better nurses! Hang in there.
HI, thank you so much for your supports. I posted update on this forum.If you type " update , heparin" as a title in advanced search , you will find a little more details and helpful informations from other nurses. I am overwhelmed by other experienced nurses' wise advice and supports.
Specializes in Nephrology, Medicine, Respirology,.
I dont think you ruined his vein....NS doesnt ruin the vein! if the patient is in ESRD then he would have need a perm cath anyways! and i doubt giving him 32cc/hr would have made him fluid overloaded so your patient was not in any harm.....heparin drips are funny..and you have to make sure you clamp the right line, otherwise the NS/D5W will run through instead of the heparin..
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
That is the most insane thing I have ever heard. NS would not ruin the pt's vein, and did not cause the pt to need a central line. I always run heparin alone, but it IS compatible with NS. Investigation?? Suspension?? Good grief, she's nuts, get a new job.
First of all, normal saline is a baseline fluid that can be run with almost every IV medication, narcotic, antibiotic, etc. I am a vascular orthopedic nurse and run heparin drips every day of the week. Saline itself can't casue venous dammage but an IV infiltrate can; to the point that the vein may have to be removed. IV
infiltrates are not something that an individual is generallly held responsible for.
When changing shift, always verify a drip with the on comeing nurse and have them sign off on it. Many nurses will blame the prior nurse for mistakes they have made, especially when a new nurse is involved.
Learn from the mistake. Anytime you are not sure of something make sure you have someone do the procedure with you. It protects you, your license and your patient
IV heparin can be run with Saline as long as the heparin and the saline are being infused on seperate pumps. I am somewhat confused by your letter.
Was the IV being infused throught the fistula or the perma cath? If so then this is wrong.. Your perma cath was probably a quintin cath? If this is not the case was the IV being infused through a peripheral line?
If infused through a peripheral line or a central there is no problem.. Who ever checked the drip with you is equally responsible.
Anne2006
3 Posts
All good nurses make mistakes. Great nurses never make the same mistake twice. Ask for a clear explanation of the error you made and how you should have performed. Once you fully understand it and know with certainty that you can do it correctly, FORGIVE YOURSELF!