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HI all...
I heard a very disturbing story tonight and thought you guys would have some input on the idea....
My mom works at a local hospital here in my area......anyway...she said that there was an agency nurse on her floor the other night (i only say agency just to point out that she wasn't familiar with this nurse since she was a temp)....well anyway..
the charge nurse went into the med room and found this nurse searching for something...she said that she had numerous med drawers out and syringes all over...sooo she asked her what she was looking for...well...and this is the scary part...
she says "im looking for a 130ml syringe so that i can give insulin to my patient".... well the charge nurse knew immediately that something was wrong...seeing as though 130 ml of insulin is enough to kill someone...but before passing judgement the charge nurse asked her, well is this a brittle diabetic? or is the patient really heavy? the agency nurse answered "no" to both...
come to find out, the nurse from the previous shift took the order off wrong and instead of 3 ml she had written 130 ml....HUGE DIFFERENCE...ok. so not the agency nurses fault technically...BUT...she didn't check her MAR with the DRs orders and the charge nurse confronted her about it and asked her why she did not check before administering meds...the agency nurse's response was "well its not my fault, i didnt write it, why should i have to check it"....
so i have a few questions....
1. is there even a syringe that holds 130ml??? i mean one that you would commonly use to admin meds?
2. Im just a nursing student, but ive always been taught that the first thing you do before admin. meds is check the MAR with the dr.s orders...or is this not common practice?
3. the agency nurse was a seasoned nurse...she is in her mid 50s and has been practicing since her early 20's (no breaks)...or so she said...why didnt that automatically send up a red flag??
4. I was under the impression that insulin needles were usually only 1ml...would there ever be an incident that you would give such a large dose?
5. to me this seems like such an odd mistake....dont you think that a nurse practicing for that long would have caught a mistake like that? I mean 3ml and 130 ml is a HUGE diff...if the charge nurse wouldnt have caught her then the pt would have been dead...although i cant imagine trying to get a 130 cc out of those little insulin vials.....wouldnt it take like a ton of vials to even make 130 cc? it just seems like such an obvious mistake..maybe im missing something? confused... :uhoh21:
i guess...i thought it was an obvious mistake but then again i'm a first semester nursing student so i thought maybe i just didnt realize or ther ewas something that i didnt know..ie..maybe some pts for some reason got HUGE insulin doses...who knows....just seems like someone who has been a nurse that long wouldnt make a mistake like that...like i said she would have given it to the pt if the charge nurse hadnt walked in...that is if she ever found her 130 ml syringe...
Only if you want to kill someone. I am an insulin dependent diabetic and have been a nurse since 1967. I have never heard of such a dose being given to a patient. And insulin IV drip, yes but 130 ml syringe, to give that amount. Not only is this nurse dangerous, she should be reported to her state's BON. At best, she needs a refresher course in drugs. At worse, she needs to lose her license.
Grannynurse :balloons:
Like I said before, I don't give a ton of insulin... I don't even give it on a weekly basis... does anyone have a sliding scale around? Just wondering how far off 130u really is... for a really large adult person, brittle diabetic, etc... I can't remember giving but just very very small amounts before... but then again, I work Peds, so that probably makes a difference!
well im pretty sure my prof said that you normally wouldnt even give 100 units, that is unless you have a brittle diabetic or a very large person..i mean the whole syringe (well the ones ive seen anyway:)) is 100 units right? and they have the little orange caps...
isnt there a limit to how much med you can give subq at one time? i know for IM they usually dont like more than 1-2 cc...2 pushing it..?
130 units is a lot but not unheard of, I've given 120 of NPH though I checked and checked and checked, then asked the patient who confirmed she did take that large a dose, then I asked her how she did it as our largest insulin syringes only go to 100 units and she confirmed she always gave herself two injections, one of 100 units and one of 20 units, so I was reassured and gave it (and she did fine). She was a very insulin resistant large lady.
well the charge nurse and my mom were discussing the situation as they were both present when it happened...and the scariest part i guess was that the nurses response was "its not my fault i didnt write it, why should i have to check it.." yikes...but the same response i had, was what the charge nurse called her out on, my mom said she heard her ask that so...i dunno...it just kinda blew me away...the charge nurse even went as far to ask this other nurse how long she had been working and when she graduated from ns...she also asked her if she even knew of a syringe that large...and then the charge nurse went on to say that the dose of insulin that she was going to administer would have KILLED the pt...i also know that the charge nurse was very upset that the other nurse didnt check the order...i cant remember if my mom said the MAR said 130 ml or 130 units...cant remember, but i do know that the bottom line was, wether it was units or ml it was a dose that was waaaayyy off....130 units, would you ever give a pt that much? I know the insulin syringe we used in class was very small 1 unit...and im pretty sure my prof said that you usually dont even admin 1 whole unit of insulin usually...but like i said im a pretty new student so i may not know...
If you are not even giving 1 whole unit of insulin you could spit in the wind, because that's about how good that would do a patient, unless it was a neonate and they needed less than a unit. If you were to simply do sliding scale insulin the ranges could go from 2units-16-18 units, just as an example...Is giving 130 ml of insulin acceptable...NEVER...is giving 130u of insulin sq acceptable, sure, is it common no...but there are patients out there who are certainly very heavy that would require a much higher dose than say a 110lb patient. Your common insulin syringe will hold 100u of insulin..equal to 1 cc...You could put more into a syringe, ie if the patient needs say 110u of insulin you could certainly use a larger syringe in order to prevent the patient from getting 2 separate shots...you just better know your conversions to make sure you aren't giving too much...
hmm i will ask my mom again tomm..exactly what the MAR said and what it was supposed to say...i just remember her saying it was written 130 something and it was supposed to be 3 something...but the reason she brought it up was bc the mistake was SO insane...that and she was already kind of weary about having surgery at that particular hosp. and after seeing that (and she did witness this first hand) she felt even more apprehensive...ill let you guys know tommorrow what she said...i swear she said it was marked 130 ml..not units..but insuling syringes come in units so i will ask her......but even if it were marked 130 units...this nurse should have known that insulin sryinges dont come in 130 units.?..or do they?
well im pretty sure my prof said that you normally wouldnt even give 100 units, that is unless you have a brittle diabetic or a very large person..i mean the whole syringe (well the ones ive seen anyway:)) is 100 units right? and they have the little orange caps...isnt there a limit to how much med you can give subq at one time? i know for IM they usually dont like more than 1-2 cc...2 pushing it..?
You'd have to split the dose if it was 130u. I thought that they made the insulin syringes all the same size, with the same markings... they are standardized to decrease mistakes in insulin dosing. The nurse could have just not known that... and didn't realize that she'd need to split the dose, and was looking for a larger sized insulin syringe. Usually, doses that high aren't given... maybe she thought it seemed reasonable for that patient, and didn't want to put the patient through two sticks. Doesn't seem as bad now that we realize we're talking units, not ML! But that's still a pretty high dose. I probably still would have questioned it.
You'd have to split the dose if it was 130u. I thought that they made the insulin syringes all the same size, with the same markings... they are standardized to decrease mistakes in insulin dosing. The nurse could have just not known that... and didn't realize that she'd need to split the dose, and was looking for a larger sized insulin syringe. Usually, doses that high aren't given... maybe she thought it seemed reasonable for that patient, and didn't want to put the patient through two sticks. Doesn't seem as bad now that we realize we're talking units, not ML! But that's still a pretty high dose. I probably still would have questioned it.
well im not so sure...bc i know the charge nurse questioned this nurse pretty intensely...i mean the charge nurse and my mom discussed how if the agency nurse were to have given the dose that the patient would definetly died...that and i know my mom questioned the charge nurse about sanctions...and if she should be reported to the board...i will find out tomm exactly what was marked and what was supp to be marked...
i dunno..i practice and practice those dosage calcs..im so paranoid about making a med error...its just so scary to think that one little math error could kill someone...yikes...do you guys still worry about making a med error or do you just get so good at it that it is second nature?
hmm i will ask my mom again tomm..exactly what the MAR said and what it was supposed to say...i just remember her saying it was written 130 something and it was supposed to be 3 something...but the reason she brought it up was bc the mistake was SO insane...that and she was already kind of weary about having surgery at that particular hosp. and after seeing that (and she did witness this first hand) she felt even more apprehensive...ill let you guys know tommorrow what she said...i swear she said it was marked 130 ml..not units..but insuling syringes come in units so i will ask her......but even if it were marked 130 units...this nurse should have known that insulin sryinges dont come in 130 units.?..or do they?
Ok, lets say that for some odd reason, the patient really was supposed to get 130 units. That's pretty rare. Maybe this nurse hadn't give that large a dose of insulin before, so she hadn't needed to go look for a larger insulin syringe. Now, that she had to give that large a dose, she was looking for the syringe to save her patient a stick.
There is a limit to how much you're supposed to give IM and sub-q. I deal with IM much more frequently, and a lot of it depends on size... a bigger person can take a bigger volume in a large muscle IM, a little baby takes smaller amounts in their "large" muscles.
Could it have been 13units? 13 is a really odd number, but there have been problems in the past with using u for units instead of writing the word out. If written sloppily, the u could end up looking like a 0. I always write out units to avoid that problem and the doctors are supposed to, also - not like they actually do, though!!
She HAD to have been simply looking for a larger insulin syringe. I don't think insulin syringes come any bigger than 100 units, though. On the rare occasions I have to give a big dose like that, I will draw up 100, transfer to a 3cc syringe, then draw up 30units and transfer that. Then use a the needle off a TB syringe since the insulin syringes we use do not have removable needles. There's just NO WAY anybody who went to nursing school would ever think about giving someone 130mls of insulin, let alone someone who has been a nurse for any length of time.
Just a little anecdote so you can see that people really can get higher doses of insulin...go to this link and scroll down to the one of many success stories section and read how high this insulin dose was at one time...and he didn't even weigh all that much..
Could it have been 13units? 13 is a really odd number, but there have been problems in the past with using u for units instead of writing the word out. If written sloppily, the u could end up looking like a 0. I always write out units to avoid that problem and the doctors are supposed to, also - not like they actually do, though!!She HAD to have been simply looking for a larger insulin syringe. I don't think insulin syringes come any bigger than 100 units, though. On the rare occasions I have to give a big dose like that, I will draw up 100, transfer to a 3cc syringe, then draw up 30units and transfer that. Then use a the needle off a TB syringe since the insulin syringes we use do not have removable needles. There's just NO WAY anybody who went to nursing school would ever think about giving someone 130mls of insulin, let alone someone who has been a nurse for any length of time.
PrickleyPear - I have seen the same notifications on writing out units instead of "U". It can look like a 0 if written in a hurry!!
I think you could give like 13 units. For instance, if the patient was supposed to get 5 units at HS in addition to her sliding scale... and the sliding scale called for something like 8u... 8u + 5u = 13u.
jeepgirl, LPN, NP
851 Posts
Like I said before, I don't give a ton of insulin... I don't even give it on a weekly basis... does anyone have a sliding scale around? Just wondering how far off 130u really is... for a really large adult person, brittle diabetic, very resistant patient, etc...
I can't remember giving but just very very small amounts before... but then again, I work Peds, so that probably makes a difference!