IV fluid mishap...worried

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So I've been having stress issues at work lately, the amount of work is starting to get to me, and I dread going there by the end of the week. So yesterday I came into work and the regular dayshift nurse hadn't called in any of the labs, one of which was stat lab for a patient with declining health that I had ordered the previous day almost 24 hours later. I called the doctor and they wanted an IV started immediatly because the patient was very dehydrated, the order was for D5W. For some reason my memory lapsed, and I grabbed D5NS instead. I just realized my error when I woke up this morning. This is only my 3rd IV on my own since nursing school, and now I'm freaking out wondering if that could have hurt the patient and if I'm going to get fired. I'd checked on this patient every half hour, and by the end of my shift half the fluid was gone and his blood pressure was within normal limits. Has anyone else ever had a dumb moment like this, and if so what happened?

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Specializes in critical care: trauma/oncology/burns.

Okay, take a deep breath......

The patient needed the fluid. Yes, you grabbed the wrong IV bag. I'd bet my remaining teeth that you will never, ever make that mistake again!

Life is a learning curve. No harm, no foul to the patient, and you have learned an important lesson as a nurse.

Keep breathing.

athena

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Specializes in Infusion Nursing, Home Health Infusion.

It will be OK.....b/c you caught it early.......NS has 154 meq of NA+ in it....so if it is administer continuously over days will begin to see the Na+ creep up....bu luckily you caught it....and if not you someone else or if the lytes were being watched.....just learn your lesson and be more careful next time....do a double check b/f you hang against a copy of the order..always always

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Yea he was only recieving 1 L and they were gonna cap it, draw a BMP and see if he needed more, or if his daughter was finally gonna sign the papers for hospice. His sodium and chloride both happened to be on the low side as it was. And this mistake is not one I'm ever going to make again.

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Specializes in Acute Care/ LTC.

don't beat yourself up. it was an honest mistake. just be careful next time.!!! the patient should be fine.

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Someone needs to talk to that day nurse about not calling critical labs to doctor. That is a serious omission.

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Specializes in Anesthesia.

It was an honest mistake and you caught it. I wouldn't worry about it, but I did want to point out the biggest problem between those two solutions is probably that D5W is isotonic where the D5NS is actually a hypertonic solution.

Just something to think about.....

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Specializes in Surgical and Medical ICU.

Actually, D5W is HYPOtonic. Also, the dextrose gets metabolized leaving just H2O. D5NS works the same way, but NS is an isotonic solution. This ort of thing is difficult to understand. Spent time becoming familiar. Like everything in the nursing world, you are either dealing with change or trying to remember what you already learned.

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Specializes in Anesthesia.
Actually, D5W is HYPOtonic. Also, the dextrose gets metabolized leaving just H2O. D5NS works the same way, but NS is an isotonic solution. This ort of thing is difficult to understand. Spent time becoming familiar. Like everything in the nursing world, you are either dealing with change or trying to remember what you already learned.

I guess it depends on how you look at it and how long you plan on using it. D5W is an Isotonic solution, but as you pointed out it becomes a Hypotonic solution after the dextrose gets metabolized. Here is quick chart so not to cause confusion for anyone else.

http://www.efn.org/~nurses/IVF.html

"IV fluid tonicity

0.9% NaCl (normal saline) isotonic

0.25% NaCl hypotonic

0.45% NaCl hypotonic

2.5% dextrose hypotonic

Lactated Ringer's solution isotonic

D5W (acts as a hypotonic solution in body) isotonic

D5 NaCl hypertonic

D5 in Lactated Ringer's hypertonic

D5 0.45% NaCl hypertonic "

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Specializes in LTC.

Honest mistake. DId the pt perk up any? When I had my son, I recieved 7000cc of IVF...Lactated Ringers from 6am til 2pm that day. All I can say is thank God for foleys! I wondered after about the 3000cc mark when my fluids were going to be eased up....since it was an OB thing I just didnt ? it for myself. By the time all was done, my legs and feet were so edematous that I didnt own a shoe or a bedroom shoe big enough to slide my feet in and I had 3+ in my legs and feet....I remember thinking OMG....whats wrong with my legs? .....Point is.....good catch on the mishap but why didnt the nurse that came in after you catch it? Did she not check the bag since it was already half gone?

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Specializes in Education, IV Therapy, Travel Medicine.

Good comments regarding not beating yourself up but, learning from error. My concern is I didn't hear mention of an incident report which would look at causative factors, # of hours worked and days on, the previous staff member's mistake, and other system issues. It is critical that this not only be done for QA but, not be used punitively.

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