How long would it take...

[memphispanda, RN]

First day on the floor as a GN instead of an extern. Second patient. Went in to assess and almost immediately noticed her left arm was HUGE. Compared it to the right arm and the right was normal size. Stopped the IV (at left AC) that had been running at 150. The arm was also in an immobilizer. OMG. Awful. The arm was so swollen it was being compressed tightly by the immobilizer. Blisters had formed outside the edges of the immobilizer--big blisters. The back of the hand looked like it would just pop. The immobilizer was soaked and the skin was weeping. It looked so bad...and the patient is non-verbal, unable to use call light.

Anyway, how long would it take for something like this to happen? I know it would vary a good bit, but to be this severe, would it take an hour or several hours or is there any way to say? The last documentation on this patient was 8 hours prior to my going into the room, and that just said that the IV had been flushed and the immobilizer put on.

[BarbPick]

At 150 an hour, about 2 hours and IV rounds are supposed to be hourly.

[Tweety, BSN, RN]

If blisters had formed it might have been more than two hours, perhaps 3 to 4.

Barb, not to nit pick, but on med-surg I've always done IV and patient checks q2h. Is q1h the norm for med-surg patients, and is that realistic with say six to nine patients on nights? There isn't much on med-surg that can be done hourly. If people need something hourly they don't belong out of a critical or intermediate unit IMHO.

Anyway, document and do an incident report, but try not to be too harsh on the shift prior, unless it's a pattern of incompetency.

I had a patient once I started fluids on a patient and went I went back her arm was the size of a huge ballon by the time I checked her again. I felt horrible, and of course the next shift made me feel worse.

[TiffyRN, BSN, PhD]

Fluids running that fast won't take too long to cause an infiltration though I don't know if that big or with blisters. Also consider the size of the arm, a 6'5" man's arm will take more infiltration than a 4'10" emaciated old lady. I did find a similar situation once (non-communicative pt, IV in the A/C). But in my case the IVF was at a slow KVO (10cc/hr) with no piggybacks, just occ. IVpushes. I was livid when I found the arm with the IV twice the size of the other and leaking at the site. I had the patient the night before and knew what his arms looked like normally. I complained to the 3-11 charge (as I was the 11-7 charge) and she (normally a wonderful charge) defended her nurse saying she was just so busy. New (rhetorical) question. . . how long does it take for an IV at KVO to make one arm twice the size of the other?

[BarbPick]

I usually work tele if I am in the hospital. This hospital has an hourly spread sheet to inital. Lots of drips going on.

Tweetyyou can nit pick all you want, you are the real deal, I like reading your posts.

[Tweety, BSN, RN]

Originally posted by BarbPick

I usually work tele if I am in the hospital. This hospital has an hourly spread sheet to inital. Lots of drips going on.

Tweetyyou can nit pick all you want, you are the real deal, I like reading your posts.

:kiss Thanks.

You're right, it would depend on the drip and the unit-specific policies.

[memphispanda, RN]

Thanks for the input! I knew it would vary greatly from person to person as well as the particular situation, just haven't had enough experience to begin to know what sort of time period would be involved. I am still in orientation (well, that's probably really obvious LOL) so I immediately got my preceptor to see what needed to be done. I don't believe an incident report was written although it probably should have been. I do know the night nurse was called just so she would be aware, but nothing bad was said to her. Definitely not a nurse with a pattern of problems like this though.