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Discussion

I was right...my preceptor was WRONG!

Well first I just wanted too say good afternoon ... I took my NCLEX this morning ... got 75 questions, have a horrible headache still from it, and I'm trying not to worry TOO much... :-/

Anyway, I have been thinking about this situation that happened since last week, and figured I could get some input from some fellow RNs :)

Toward the end of one of my shifts last week, my preceptor (actually, my 'substitute preceptor') came in the patient's room with me while I was giving a heparin injection. I proceded to clean the patient's abdomen with alcohol, squeeze the skin, and inject the needle at a 45 degree angle, just like I was taught to do with SQ injections. Well, I begin to push the medication in and my preceptor goes, 'WAIT! You didn't aspirate! See?' And she procedes to ASPIRATE even after I've already pushed some medication in. Blood enters the syringe and she says, "See? You hit a vessel. This is why you always aspirate." As I'm looking with disbelief, unable to even think of how to respond, she procedes to REMOVE the needle and RE-INJECT the patient, on the other side of the belly WITHOUT cleaning it, and ASPIRATES first (this time, she says, 'No vessel was hit') and procedes to inject the rest of the heparin in.

*SIGH*

Now, please, please... correct me if I'm wrong. I know I'm just a 'lowly' new grad and being in the ICU, I commonly feel like I should just shut up and listen. However, I can't stop thinking about this and I feel like I should have said something right there as she was doing it. I thought that you're never supposed to aspirate heparin/lovenox/ SQ??? I mean, does she aspirate insulin too??

I'd love some input on this... thank you in advance~~

Jess

Featured Replies

Good luck on the NCLEX!!

Sounds like your sub preceptor really goofed!!!

Whatever you do, keep the "I was right" part to yourself. The ICU is a daunting place on the best of days, everyone makes mistakes. Just file this away as "lesson learned" . 'seasoned' ICU nurses can/will make a new grads life hell.

YOU know you did the right thing.

Keep smiling!

I don't aspirate for heparin injections in the abdomen. We use sub-q injections sites that are not areas with large vessels. Yes you might easily hit a capillary occasionally but that is not gonna be a problem.

You don't aspitate with ANY sub Q injections, period. But you especially don't do it with heparin or lovenox or any other hemolytic/anticoagulant medication. Furthermore, there are no "vessels" to speak of in the abdomen that you could hit with a sub Q needle. The only vessels there are capillaries and heparin et al can cause an immediate blood return because they're designed to facilitate bleeding. Sheesh.

You were right on the mark. Did you speak to anyone about this? What your preceptor did was not life threatening, but it could cause significant (and unnecessary) bruising. I hate to think she's doing this on a regular basis.

BTW, a shut-off at 75 questions is almost always a good thing. I'll say congrats in advance. (You obviously knew your stuff in the above situation.)

I had a similar situation, during my clinicals (I was giving insulin). I brought it to my instructor, and she said that I was correct for not aspirating, but many 'old school' nurses still believe it is necessary, and continue to do so.

Congradulations, on your NCLEX!!

Just keep doing it the way you are. You are right this time. Keep in mind that you may have been shown other things on school or orientation that are incorrect, and the one who shows you a new way IS correct. Don't assume theres only one way. We have all encountered this type of thing and just keep it quiet in this case. I agree that 75 questions on nclex is usually a good thing!

Well if it were me I'd probably keep quiet about the aspiration thing, but the reinjection thing is just bad nursing, I'd have told my instructor. That is dangerous and someone needs to make sure she knows she's doing something wrong and potentially harmfull!

PS Good luck with the NCLEX.

my book says do not aspirate when giving heparin by subcutaneous injection because aspiration can possibly damage the surrounding tissue and cause bleeding as well as bruising.

Heck the aspiration thing be darned. I want to know what she was thinking taking the needle out and resticking in another area that wasnt even cleaned first. Nothing like a big ole abcess to cause a problem.

You were right in your assessment of the situation, and i agree its better kept to yourself about your "being right".

Congrats on your 75 question test, im sure you did great. You will be a good nurse and a better preceptor.

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