IV safety

[MB RN]

I would appreciate comment on the following: Last evening I ran afoul of my supervisor when I advised that a patient with an IV of D5 1/2 and NS with 20 meq of kcl was in need of a new site. The rate ordered was 75 ml/hr. With the nut wide open, only half the amount was being delivered even when the arm was in an ideal position. When she raised her arm, even slightly, the drip stopped altogether.

The patient was receiving the second of three 1,000 ml bags ordered. Not only would she not achieve the prescribed amount, I reasoned that if the catheter was resting against a vein or was blocked by a small clot, repositioning could release the blockade and potentially cause a sudden increase in the volume delivered. If this occured while unatttended, she could recieve too much fluid and kcl in a short period of time. This happened on the 3-11 shift and the nurse due on 11-7 was an LPN who would be responsible for my unit and another; more that 70 beds!

The supervisor reasoned that since there was no evidence of extravasion in the tissues and that she suspected the MD would dc the IV in the AM, it was of no importance. She forbade me to intervene and said I need not attend it further as there was an LPN on that sector and she was "qualified" to intervene.

This poses not only ethical but legal questions, especially since there was a drug in the solution. Incidentally, at the end of the shift only about 50% of the solution due was actually delivered. Thanks for listening.

MB RN

------------------

[PICCONE]

Just one stupid question.

Why get your supervisor involved? Normally an RN acts independently except for unusual problems. Why didn't you access the site, make your decision,speak with the patient about what you wanted to do, and then replace the IV site. Other options could include seeing if the patient really needed the IV or could they take PO especially if there was a good chance the IV would be D/C'd in AM.

Arlene Cowen RN

[email protected]

[MB RN]

kewlnurse,

Sorry for not being clear. The deficit was 300 ml; half the amount that should have been infused so, it was behind by 50%. No, we don't have pumps. Not even a lousy DynaFlow device. It is a nursing home and sometimes I wonder if we have any business at all doing IV therapy given the stubborn refusal of the DON to purchase the proper equipment. Unfortunately, you find this almost everywhere.

-----------------

[MB RN]

kewlnurse,

Sorry for not being clear. The deficit was 300 ml; half the amount that should have been infused so, it was behind by 50%. No, we don't have pumps. Not even a lousy DynaFlow device. It is a nursing home and sometimes I wonder if we have any business at all doing IV therapy given the stubborn refusal of the DON to purchase the proper equipment. Unfortunately, you find this almost everywhere

[MB RN]

Thanks for your reply, Arlene. Your questions are certainly valid. I didn't directly get the Supervisor involved. She was called by the LPN who complained to her that I was horning in on her side and she felt sllighted. She arrived on the unit in response to the (agency) LPN.

The pt. needed the IV because she is unable to take anything by mouth reliably. Everthing we are giving her is washing into the colostomy bag as she has end stage bowel cancer.

The IV tubing had no ports to flush, unfortunately, so that was not an option. This occured on a Sunday evening and the supervisor was unwilling to call the MD. At my facility MD's are called by Supervisors or only with their permission. I should also tell you there was no DynaFlow or Pump. This IV was being regulated by the nurse. The pt. is only semi alert; cooperative but too confused for a discussion of options.

MB RN

[MB RN]

Thanks for your reply, Arlene. Your questions are certainly valid. I didn't directly get the Supervisor involved. She was called by the LPN who complained to her that I was horning in on her side and she felt sllighted. She arrived on the unit in response to the (agency) LPN.

The pt. needed the IV because she is unable to take anything by mouth reliably. Everthing we are giving her is washing into the colostomy bag as she has end stage bowel cancer.

The IV tubing had no ports to flush, unfortunately, so that was not an option. This occured on a Sunday evening and the supervisor was unwilling to call the MD. At my facility MD's are called by Supervisors or only with their permission. I should also tell you there was no DynaFlow or Pump. This IV was being regulated by the nurse. The pt. is only semi alert; cooperative but too confused for a discussion of options.

MB RN

[kewlnurse]

Thats a nurisng judgment call, pull the old one and start a new one. Don't you use pumps? With only half the bag (500 ml) being gone at the end of the shift your not too far behind schedule, 75 ml/hour is 600 ml for 8 hours.