misdirected venipuncture

[OITnurse82]

Hi

Curiousity is mine. Recently an RN at my facility inadvertently inserted an IV in the basilic vein- with the cannula aimed distally. Amazingly the 50ml of antibiotic infused , the patients site remained normal in appearance and caused no pain. The mortified RN who realized that this had happened approached a conscientious and experienced internal med doc who reassured her that " it was ok"- the diameter of the vessel had not occluded flow and it just went out peripherally before returning to the central vasculature.

Another nurse wrote up the incident and stated it was setting the patient up for DVT or phlebitis- who is one to believe?

of course one would never want to do this again but I am seeking anecdotal or other knowledge re this...

[canoehead, BSN, RN]

It would certainly cause greater irritation to the vein, and shows a lack of knowledge about anatomy that the nurse should have down cold. I don't like writing people up when a conversation would do the trick. I guess if this is a pattern for her an incident report would be worthwhile.

[Binkey, BSN]

Though I would feel inclined only to speak to the individual in question, (versus writing him/her up), I would inform them though that directing the cannula away from the heart is an inappropriate VP technique. The problem exists in the fact that when a catheter is placed in the upper extremities and the tip is aimed toward the heart, there is less trauma to the tunica intima than if it was placed in the opposite direction. Think of it this way: You have a catheter that is not flowing with the blood flow, but against it. Therefore,

it is getting "whipped" around from the turbulance of the vascular system and thus the nurse who said that there is an increase risk of phlebitis and thrombus is correct.

:uhoh21:

[OITnurse82]

thanks for the input about the misdirected venipuncture...

I feel the same way about the handling of the incident-a one to one conversation instead of the invested energy that it took to fill out forms could have cemented concerns for the patient and the nurse rather than the opposite effect that discussions that are punitive, critical and mostly unprofessional in scope. Without fingerpointing I think this could be an opportunity for education with the individual and others like me who are curious!

l

Hi

Curiousity is mine. Recently an RN at my facility inadvertently inserted an IV in the basilic vein- with the cannula aimed distally. Amazingly the 50ml of antibiotic infused , the patients site remained normal in appearance and caused no pain. The mortified RN who realized that this had happened approached a conscientious and experienced internal med doc who reassured her that " it was ok"- the diameter of the vessel had not occluded flow and it just went out peripherally before returning to the central vasculature.

Another nurse wrote up the incident and stated it was setting the patient up for DVT or phlebitis- who is one to believe?

of course one would never want to do this again but I am seeking anecdotal or other knowledge re this...