heparin mistake

[ernurse77]

Hi all this is my first post and im freaking out as i have been working the ER for about 5 months and i had a pt come in with a MI and they had 2 IV sites one was nitro which i immediately put on a pump and double check with another nurse. The other i thought was NS and i opened it wide. As i was getting the pt ready for cath lab 2 hrs later i realized the NS was a bag of 25000u of heparin empty. I told the cardiologist and the rn taking the pt. This was a couple of days ago and i havent heard anything. Ive been doing research on this topic and not finding alot of information except that this is bad. The pt was approx 125 kgs and male. How much damage could have happened? All i am finding is a pt shouldnt ever gey more than 5000u bolus or 100u/kg is the largest dose. I feel terrible. They came off the ambulance and i didnt look closely as i was so focused on the nitro.

[TriciaJ, RN]

For heaven's sake, call your charge nurse or manager and ask what happened subsequently. If the outcome was really bad, it's hard to believe you would not have heard anything in 2 days. No news is good news. But call someone in charge, let her know how sick you are about this, ask what happened and what happens next. Sitting around worrying does no good. My stomach is in knots just thinking about what you are going through.

And good luck. The outcome might be all right.

[Esme12, ASN, BSN, RN]

Welcome!

((HUGS)) Yes it is a big mistake. I am not crazy about the initiation of heparin gtts in the field...bolus yes...gtts not so much. I cringe with titrated gtts and no pumps. I wish they were required to use at least syringe pumps. This is where big mistakes happen. As a new grad the ED is challenging...there is so much to watch out for, so much to do.

I have several questions.

How many mls of fluid as the heparin mixed in?

Why did you open the bag wide? Was the patient hypotensive?

Were you the nurse who received report from the medics?

Who stated the heparin?

Did EMS also start the nitro?

How does EMS regulate their gtts?

Did you fill out an incident report?

Did you tell your charge/manager/ED doc?

If it is driving you crazy call them.

To set your mind at ease about untoward outcome.....a patient is bolused with at least 10,000u of heparin at LEAST once for a cath procedure and sometimes is bolused again when a plasty intervention is begun. If the patient went to open heart he was given a whole lot more heparin than that to go on pump. Heparin can be easily reversed, and is reversed after the procedure, with Protamine Sulfate.

A good rule of thumb....never open wide a bag that is less than 1000mls. This way it makes you check what is in a bag with less fluid.

A lesson learned...ALWAYS LOOK at EVERY single bag hanging EVERY time. I am sure that you will not make this mistake again.

Let us know what happens ((HUGS))

[ernurse77]

Thankyou so much. I believe it was initiated at the previous hospital but then taken off the pump for the ride. I was not the nurse taking report upon arrival and it was a super busy night. Thankyou for setting my mind at ease. I worked on an inpt med/surg floor for a year before the ED and have not done alot of these cardiac things. I havent had a med mistake before.

[Esme12, ASN, BSN, RN]

It sucks....but mistakes happen. I have instituted policies that require local EMS upon presentation to the ED the nurse who receives report is responsible for place titrated gtts on pumps immediately. I successfully got it required at one facility that ALS transport is with a nurse from the sending facility if the ALS rig was without IV pump capability. IF this becomes an issue....I would suggest to management that you would like to spearhead a committee for the safe transport of ALS patients with titrated gtts and develop a teaching opportunity for local EMS, and staff, on the importance of the reporting and transfer of titrated gtts.