Immense guilt

[FutureNurse0201]

I had to post here because I am not sure how to cope with my emotions after three rough shifts in the morning. Today is my day off and I just can’t let it go.

So, to make story short, we were severely understaffed all three days. Yesterday I had 5 patients with two primaries. We are ICU step down and three (or four) patients should be maximum we got with pct/CNA to help. 
Night shift had a rough night as well with 3-4 primaries and nothing was done. On top of everything I am 37 weeks pregnant and can barely walk. 
Anyway, I had a blood draw at 07am which was done at 09.30 from PICC line, double lumen. One port had dopamine running. The other one worked fine.  At 5.30 pm, I had to do another blood draw and port wasn’t flushing. So, I put dopamine to run through the port that wasnt flushing (it actually worked) and drew from the other one. I knew that is was most likely occluded with dry blood (possibly I forgot to flush the blood back in the morning but no way to know for sure). Since it was now 6pm and residents are doing their shift change, I decided to pass this info to night nurse who is very experienced and was also charge. I told her if doctors don't want to do anything to just pass it on to day shift. 
When I was driving home, I realized that I should have just taken action (page Dr, ask for TPA or something). I am relatively new nurse and never had to do it so I wasnt sure what the protocol was.

Now I feel guilty. What if blood clot from PICC goes to the heart? Or if dopamine running causes it to dislodge? What if nurse doesn’t pass the info and they sent patient home today with one port occluded? How serious is occluded PICC line and what should have I done? 
 

Thank you. Sorry about random thought. I still feel exhausted from the last three days from hell. 

 

[LovingLife123]

Lumens on PICC lines become clogged often. What you are envisioning happening doesn’t happen.  Do you not have a policy where your picc line is flushed every 8 hours?  
 

I understand you had a crazy shift.  5 patients in stepdown is way too many and is why all the proper things can’t get done.  I’m so sorry you had to deal with such a high patient load.

[JBMmom, MSN, NP]

Take a breath and give yourself a break. Things happen. It's not the end of the world. PICC lines are commonly difficult to draw from and do often get occluded. You were busy and you passed something along, it's a 24 hours job. If someone else didn't act on the information you passed along that's not your fault. You've obviously got a lot going on at work and at home, get some rest and take care. It's going to be just fine. 

[LibraNurse27, BSN, RN]

I have seen this a few times, where a PICC line had something running into it that was infusing just fine, but when I paused the infusion to draw blood it would flush but then no blood would come back. Yes it would be good to start the unclogging process, but on a crazy shift like that you have to prioritize. Things get passed to the next shift all the time, and I don't think this is a huge deal to pass on.

[NightNerd, MSN, RN]

Relax, breathe, and show yourself some grace! It sounds like your shifts were pretty hellish, and sometimes stuff has to be passed on. Sometimes PICCs occlude too, and it's okay! Yes, it would have been ideal to page the provider and treat per your hospital's protocol, but you had to prioritize and it's not a tragedy that it didn't happen until the next shift.

Just make sure you know your protocols, or at least where to look them up, so that way you have a reference for when you're not sure of something in the future. You can also discuss with your charge nurse to check if you're doing your due diligence. This is not me saying you did anything wrong; I just want you to feel confident that you'll have an idea of what to do next time!

Please let yourself enjoy your day off! It's hard to shake off one bad shift, let alone three, but it sounds like you did the best you could and took care of ther most important things, and it's okay to leave it at that. You can take some learning from this so you can tackle it differently in the future, but you truly did nothing wrong and this will not harm the patient that blood couldn't be drawn from the line. (Also, sometimes they can just be weirdly positional, so I may try turning the patient, having them raise an arm, etc.)

[FutureNurse0201]

Thanks to all who responded. Yes, I know PICC lines stop drawing blood sometimes. But in my case it stopped flushing (only one port, the one I drew blood from in the AM). The other one where dopa was infusing was fine and it draws blood. So I switched infusing to go through occluded port and it did work. 
but to be honest I wasn’t sure if it was a blood clot (most likely) or something else so I kind of left it to charge nurse (who had the patient) to look at it and also today is Monday and was thinking IR will maybe deal with it (if it gets escalated at all). Anyway, that was my chaotic, thought process one hour before the shift ended. Also, I was thinking even if I paged MD, they may not do anything because it is night service and they cover the entire hospital and just deal with acute problems 

[speedynurse, ADN, BSN, RN, EMT-P]

Nursing is a 24 hour job. You can only do what you can do. And even if you did stay over, there would be a million more things left to do. I learned this the hard way in the ER. 5 stepdown patients to a nurse is too much in my opinion. Do what you can do and do the best you can in a shift and move on.

[2BS Nurse, BSN]

You could always ask to spend some time discussing PICCs with an experienced nurse. I quickly realized there are so many tricks to trouble shooting PICCs that you never learned in nursing school. You won't find them in any policy. Whenever I'm unsure about something, I do the research so I can fix it the next time I encounter the situation. That's all you can do!!