I'm going to refuse to draw his blood.

[Jo Dirt]

I'm doing HH and have had the house from hell this week.

The guys has a PICC line and was ordered to have daily gentamicin troughs drawn for one week.

I know this is rambling but I'm losing sleep over this and just need to get it out.

Another HH agency usually deals with his PICC line but they said on Friday evening they didn't have the staff to cover him over the weekend (they didn't want to do the dirty work of running his labs all over the country to a hospital that would take his insurance)so the agency I worked for agreed to take it over, even though they would not be reimbursed for the lab draws (they did it as a "courtesy" because we provide his private duty nurses).

This courtsey meant I would run the wheels off my own car and be tied up with this all week.

So a couple of days after the first two draws the PICC line stops up and you can get meds in but no blood out.

So I have to take his blood through venipuncture.

His sister is his primary caregiver and I would say she is low IQ/mildly retarded (the whole family seems a little off) and very protective of her brother. Yes, this is good, but what has happened is she has requested another RN come in to take over. She is blaming me because the PICC line stopped up (the DON quickly told her this did not necessarily have anything to do with my RN skills) so then she said I didn't know how to do blood draws. I had to poke her brother twice and one time I had the needle in upside down (this is not true). The DON told her this was also not a pick and choose option, I was the only RN they had in this area but she always had the option to refuse our services. For one reason or another she decided it was okay for me to come back one more time.

After this I REALLY did not want to go back but the DON asked me to please do it because this would be the last time it would have to be done.

So, I'm set to go out this morning. But I've really had my fill of this situation. I am out of butterfly needles which are the only needles I feel comfortable using to draw blood and I've got the vacutainer needles but if the LPN out there doesn't know how to use it I'm not going to attempt it.

I am going to tell this sister if she wants the other HH agency she is going to have to take the initiative to call them.

I just wonder if you have ever been in a similar situation where the family wants to blame you for everything? I've bent over backward to be accomodating to this sister.

[beautifulb]

This has definitely been a difficult case for you. :icon_hug: Many family members have blamed me for something I had no control over. It feels like no matter how hard I try, some are just not easy to please.

[Nurse_Ben]

If you have already tried heparin therapy, maybe get an order for TPA therapy and get that PICC going again. :>

[Dorito, ASN, RN]

Sometimes if you reposition the arm you can get blood. I did home health for several years and that is frustrating when you can flush in but not get blood out. They often will get a Fibrin sheath around the end of the Picc. I agree with the Heparin route. I know it must be frustrating with the sister there scrutinizing your every move.

[tbinghamlpn]

I'm doing HH and have had the house from hell this week.

The guys has a PICC line and was ordered to have daily gentamicin troughs drawn for one week.

I know this is rambling but I'm losing sleep over this and just need to get it out.

Another HH agency usually deals with his PICC line but they said on Friday evening they didn't have the staff to cover him over the weekend (they didn't want to do the dirty work of running his labs all over the country to a hospital that would take his insurance)so the agency I worked for agreed to take it over, even though they would not be reimbursed for the lab draws (they did it as a "courtesy" because we provide his private duty nurses).

This courtsey meant I would run the wheels off my own car and be tied up with this all week.

So a couple of days after the first two draws the PICC line stops up and you can get meds in but no blood out.

So I have to take his blood through venipuncture.

His sister is his primary caregiver and I would say she is low IQ/mildly retarded (the whole family seems a little off) and very protective of her brother. Yes, this is good, but what has happened is she has requested another RN come in to take over. She is blaming me because the PICC line stopped up (the DON quickly told her this did not necessarily have anything to do with my RN skills) so then she said I didn't know how to do blood draws. I had to poke her brother twice and one time I had the needle in upside down (this is not true). The DON told her this was also not a pick and choose option, I was the only RN they had in this area but she always had the option to refuse our services. For one reason or another she decided it was okay for me to come back one more time.

After this I REALLY did not want to go back but the DON asked me to please do it because this would be the last time it would have to be done.

So, I'm set to go out this morning. But I've really had my fill of this situation. I am out of butterfly needles which are the only needles I feel comfortable using to draw blood and I've got the vacutainer needles but if the LPN out there doesn't know how to use it I'm not going to attempt it.

I am going to tell this sister if she wants the other HH agency she is going to have to take the initiative to call them.

I just wonder if you have ever been in a similar situation where the family wants to blame you for everything? I've bent over backward to be accomodating to this sister.

That is just part of being in home health. It is not necessarily you that may not like, there are personality conflicts anywhere you go. As being Office Manager of Home Health and Hospice, I get them phone calls about every one of my nurses.

[TazziRN, RN]

It's frustrating to be blamed for something that is not your fault, but that comes from ignorance on the part of the family/pt. It happens to all of us. You're doing the best you can and I think you're making the right decision.

[Antikigirl, ASN, RN]

Is there an infusion RN specilist home health department or services you can contact to have the line fixed or redone? I know that when I was working ALF we had that service if needed.

Also, I would call the MD and explain what happened to the line, what you did, and have them re-evaluatate the need of the blood draws if at all possible. Sometimes I have talked to the Doc, explained what was going on, and they would D/C or change things to be a bit more accomidting to family/patient and nurse :).

I may also choose to have a sit down with the sister and say that you appreciate her strength and protection of her brother, and you are on their side, however things like this do happen commonly because of the bodys way of protecting itself from anything foreign in the body! That is can happen at any time once the immune system kicks in...and since he is on an antibiotic..well, his immune system is certainly kicked into high gear!

Sometimes when I get a patients family member doing this, I show them what I am doing...and explain each move and pro/cons or things that can happen. Typically that works out well...giving them more information and hopefully aiding in their powerlessness or hopelessness of the situation. Also never forget to add that some nurses do it differently because of different training with equipment and comfort level...and experience!

Good luck to you!!!!!!