IV push failure - how I am failing

[Brandazzle1]

I am new to the hospital environment and brand new to IV meds so when my preceptor said it was a mistake not to pause the heparin drip before doing an IV push dose of morphine I expressed understanding and told her I never knew that. I honestly don't remember learning that in nursing school so she told my boss and now they've added another week of orientation for safety concerns.

I am terrified they're going to fire me. I already had an extra week of training to hone my time management skills and then I do this! I just worry that there are other deficits in my education that will lead me to endanger a patient or get fired and I'm 37 weeks pregnant so I'm about to go on leave without really being on my own. I just feel like I'm failing and the preceptor says I didn't seem to understand how serious this mistake was. She's right. I didn't. I don't know what I don't know, you know? Are there other things specific to IVs that I should be aware of before I kill someone?

[psu_213, BSN, RN]

I'm honestly curious, because your hospital's policy strikes me as a little scary. I get that there are risks to inserting peripherals for sure, but if you have a patient receiving a heparin drip because of a MI, that person has the chance to code.

I think you missed Muno's first sentence when he states two IVs are warranted in "some situations." An acute MI is one of those situations. I think the point it, just because someone is on a heparin drip (and many fairly stable patients are on heparin drips) it does not mean the pt. must have a 2nd PIV.

[JustKeepSmiling, ADN, BSN, RN]

Or you could aspirate the high risk drug out to avoid a bolus, give your push, flush then restart the line. Avoid fooling with high risk infusions for pushes if you can avoid it though.

Please don't do this. You risk clotting the line if it is a PIV. Also you don't want to stop levo or other high risk meds just because. Your pt could

tank very quickly and it can be difficult to get them back. If you have to give IVP meds etc it's best to have a second line. High risk meds are just that, Mess with them cautiously. Hope this helps some. I see you are new to the ICU.

You misunderstood me. I deal with a very difficult population involving IVDA, dialysis, etc that have crap for access. When you only have one TLC and have trifused it to the max, sometimes the only option is to pause a drip.

I'm not talking about pausing levo at 3 when the MAP is a mere 50. I'm talking about a 0.01 to keep SBP>100 and when turned off it hangs at 95. Hardly something to be in a complete tizzy about if the patient truly needs a push.

[ceneil76]

Brandazzle1 I agree and I think that not enough space in the hospitals is a problem for a number of nursing programs. I also think it can be hard for every student to get all the opportunities we need to learn about how to do IVP meds and other procedures. Along with not enough space was often not enough patients for all eight of us in my clinical group. I feel that often my instructor was really trying for us to have opportunities to do IVP meds but some days we did not get them. I feel that this fact leaves some of us with vastly different experiences.

[Jory, MSN, APRN, CNM]

Glad I wowed you.In orientation the orientees are there for guidance.They require someone to tell them the information. And.. that's okay!

Never took the NCLEX. However, I did enjoy precepting the many nurses that required my teaching skills. I did not challenge them.. or refer them to a manual. I taught them how to apply what they learned in school into the real world. They all succeeded. Nothing beats learning by example.

Signed,

Crusty Old Bat

There is no standard in learning by example. That's why there are policies and manuals.

My unit had a guide that was specific to my area of nursing. That became your best friend you first few months of employment. What if someone tells you wrong? Who is liable? The person that told you wrong or the nurse that administered the medication. That would be who administered it. Relying 100% on coworkers is dangerous.

The standards of giving medication are taught in every nursing program in this country and every hospital has a source where nurses can look up incompatibilities or rates. Rates varied very little when I started working the floor on my own and typically was related to another condition that the patient had. There are flushing protocols and other nuisances that vary by facility that are learned in orientation.

[allieb1984]

I dont know if its been mentioned, but when I was precepting as a student nurse, I was on a MS/Onc floor. Some meds you can flush and some you can not as this would be giving the patient a bolus . So the patient had multiple lines.

[applesxoranges, BSN, RN]

Were you using the same line or a different line? Was it a central line? I wouldn't have stopped the heparin because the heparin is a dedicated med line (and ran with other compatible stuff) and we usually have normal saline running or an INT in a 2nd location. I think we would be scolded for sending a patient to the floor with no other access.