My nightmarish experience

[Anona]

I had been having an okay time on orientation-- it was stressful but I had had a good night last night when something AWFUL happened. Now I'm wondering if I should even be a nurse...

It was toward the end of my night shift a few days ago and I was changing antibiotics. The patient was aleeping, and had been very uncooperative and refusing meds, so I didn't turn on the overhead light, just worked under the dim light of the room. A few minutes later the pt. started to complain of chest tightness. I grabbed my preceptor and a dr. Dr. said she looked alright. Then, a few minutes later, a surgical resident came in. He noticed that the port on the patient's CENTRAL LINE was off. He brought me in the room with a bunch of residents to tell me how serious this is (and I understand why. it IS serious.). I wanted to die. At that point the patient was feeling somwhat better, and the port was capped.

I cannot express how much I hate myself right now. They're giving the pt. a CXR to make sure he doesn't have a PE (which, in my mind, he definitely does have). This is a CANCER pt. I am horrified that I've added to his pain and placed his life in jeopardy. This is EXACTLY the kind off stuff I'm terrified of as a nurse....

The nurses on the floor told me to calm down and go home. They told me that mistakes happen and I shouldn't lose it over this. I went home, thew up a couple times, sobbed, and then went back to work. Saw the pt. walking and talking, but I also know pt.'s can walk and talk with a PE. I found the nurse manager and told her everything: I wanted it all to be out on the table. She said that she would right an occurence report, but that I was a good beginning nurse and to take it as a learning experience... BUT I can't stop crying. I realize the seriousness of this. It could have been much worse. I go back to work in a couple of days, but don't know if I can or even SHOULD face it. If I'm incompetnent I don't want to work as a nurse. It's too important of a job. I didn't even NOTiCE this: what might I not notice in the future, however vigillant I am?

Can't stop crying, I even called a therapist (an APRN, haha) and made an appointment for tomorrow. Anyway just venting... need advice. Am I too dangerous for this? And if I'm not, will I even be able to practice again with all this fear?

Nona

[Anona]

Thanks again guys.

I guess the part that was dislodged was the 'catheter tip,' if that helps to clarify. On a peripheral line it would be the white part. It's the part that keeps the air out. Only the purple cannula part was visible. This was made far worse by the fact that the clamp was apparently also open at the time it was discovered. Anyway, if I can help anyone else from going through this, it gives me some solace. For days now I have been reading about all of the horrible things that can happen with a pulmonary air embolism... If I do continue in nursing, I will always quadruple check the catheter tip AND the clamp.

Nona.

[deeDawntee, RN]

Hey Anona,

You have to give yourself a HUGE break here. It would be extremely difficult for air to travel down a central line and if some air did go down the line, to have enough to create a dangerous air embolism would be extremely remote. I can't tell you HOW many times I and all the nurses I know in the ICU hang antibiotics in the semi-darkness to allow pt's to rest. It is an unbelievably unfortunate fluke that what happened happened and a bunch of residents scolded you for it. They are being jerks, if you ask me. How do you know that the central line wasn't faulty? You just don't know. You are an easy target, an older nurse would have deflected that issue..."how the heck did that happen?"

Nursing is an extremely humbling profession. We all do stupid stuff. You have to allow yourself your humanity. Do not allow yourself to practice nursing in fear. Do your best, admit your mistakes and keep on keeping on....and the most important thing is to FORGIVE yourself.

[Mommy TeleRN, RN]

Anona- I had an incident this week also. I know exactly how you feel. Sometimes it's such a simple thing when we try to do the correct thing and we try to go above and beyond and you still make an error. It's so hard being new and trying to do it all right. And then not really knowing how "big a deal" it really is I think makes us even more terrified. Thankfully my patient seemed to be ok too but I still feel terrified to mess up

[rita359]

Calm down!! You say you saw the patient up and walking around. She surely wasn't hurt as bad as you are whipping yourself over her being hurt. She obviously did not have an air embolism or she would not be up walking around. Would not be likely anyhow, in my opinion. More likely you would see blood on the sheets than air going in if cap off port. That didn't happen either from your description. If you learn one thing from this it is to light up your environment when you are doing something. Easy solution for helping keep other things from happening. Good learning experience for other new nurses on this site and older nurses too. Something you probably didn't learn in school as most school experience is during daylight hours. Also,believe me, nursing is a job you never stop learning at. Not all you learn will be learned the hard way (through mistakes) but some of it will.

[morte, LPN, LVN]

Hey Anona,

How do you know that the central line wasn't faulty? You just don't know. You are an easy target, an older nurse would have deflected that issue..."how the heck did that happen?"

Do your best, admit your mistakes and keep on keeping on....and the most important thing is to FORGIVE yourself.

my thought as well, i would presume the part you are speaking of is the cap on the end? as much as i can remember they screw on...perhaps some of the thread was broken.....or cross threaded....etc

[reesern63, RN]

Thanks for your words... it helped a little.

part of the reason it happened was that i was so freaked out about hanging the wrong med or having air in the LINE i didn't even notice the port had come off... it's these things i don't know to check for that really scare me. i can't believe that i was so worried about a med error-- most med errors are FAR, FAR, FAR less serious than this.

have been reading about central line PE on the 'net. it's really scary stuff. i keep seeing pages that talk about permanent damage and high fatality rates. i'm seriously considering not going back to work this week. even if the patient is ok (and i pray to god she is), i'm just not confident in myself--and can't handle the risk that i may harm someone. don't know what i'll do instead...

i'm so ashamed and worry about the potential impact on my family if i can't work.

OK, you need to stop reading stuff on the internet RIGHT NOW!! GET IT?

You made a mistake in that you let a grumpy pt. intimidate you into trying to administer a med under less than optimal conditions. You should have had adequate light to see what you were doing. Too bad if it annoyed the pt. I hate to sound harsh, but your task was more important than the pt's sleep being interrupted for a few minutes. This is a mistake I am sure you will never make again. The pt sounds like he hasn't suffered irreparable harm. You, however, are going to do yourself irreparable harm if you keep obsessing on what could have happened. It didn't. Learn, and move on.

Talk to the therapist about how you can turn this into a learning experience. And next time, don't let a pt. bully you into trying to do a procedure under suboptimal conditions. Pt's are in the hospital for medical care. It's a hospital, not a hotel.

You absolutely belong in nursing. If you didn't care about what happened, then there would be a problem.

[reesern63, RN]

Hey Anona,

You have to give yourself a HUGE break here. It would be extremely difficult for air to travel down a central line and if some air did go down the line, to have enough to create a dangerous air embolism would be extremely remote. I can't tell you HOW many times I and all the nurses I know in the ICU hang antibiotics in the semi-darkness to allow pt's to rest. It is an unbelievably unfortunate fluke that what happened happened and a bunch of residents scolded you for it. They are being jerks, if you ask me. How do you know that the central line wasn't faulty? You just don't know. You are an easy target, an older nurse would have deflected that issue..."how the heck did that happen?"

Nursing is an extremely humbling profession. We all do stupid stuff. You have to allow yourself your humanity. Do not allow yourself to practice nursing in fear. Do your best, admit your mistakes and keep on keeping on....and the most important thing is to FORGIVE yourself.

Uhm, I'm an "older" nurse, and I will not mess around with a central line in semi-darkness. That's just bad practice and it's asking for an error. And I kind of resent the "older nurse would have deflected it" comment, as if we try to pass the buck. Speaking for myself, if I make a mistake, I own up to it.

[ohmeowzer RN, RN]

honey you are only human. you are learning a new job and it is a complicated and stressful job at that. you are not incomptent and sometimes we forget things, or pt's don't like us .. your okay and you will learn from this and move on. believe me in a few weeks this will be history. you are in my thoughts and prayers. give yourself a big hug for me.

[SuesquatchRN, BSN, RN]

For days now I have been reading about all of the horrible things that can happen with a pulmonary air embolism

STOP IT!

You're gonna guilt yourself right into insanity.

STOP. IT. NOW, missy.

:)

[montieICURN]

have been reading about central line pe on the 'net. it's really scary stuff. i keep seeing pages that talk about permanent damage and high fatality rates.

great!!! this is why you will make a good nurse.

stuff happens...for various reasons. sometimes the patients disconnect the line, or pull the line...if your central line comes apart and you fear air has entered the port....prior to recapping the port place a 10cc syringe on the port. attempt to withdraw all air from the port, and withdraw until you get about 10cc of blood back. also, if the port in question is not the distal port, i would withdraw blood from that also...being the furthest port in, you may catch some air bubbles that got by...maybe.

what you have learned is to check the integrity of all ports and all caps (and check the dressing) prior to leaving the room. (your preceptor should have already taught you this) that way when this happens again, and it probably will, you will know it was intact when you left the room. and by the way, the same applies to picc lines, for they are also central lines!!! don't worry about it, just learn and move on.

[gaikoknifenyom]

This is all really good to read. I am actually beginning my first day into nursing school tonight and my true fear is to make a mistake that will hurt a patient. As wierd as this sounds, I am glad I won't be the only one blowing it from time to time.

[brwneyegal]

First thing you need to do is step back and take a deep breath! Every nurse has made at least one mistake in their career. We are human, ya know? The shere fact that you feel the way you do is proof that you will be a good nurse.

When you go back to work make sure as I know you will check, recheck and recheck all your meds and sites before you give meds.

The residents who yelled at you were only trying to make themselfes look good. Do not let them intimadate you. Stand up for your self and move on. Next semester there will be a bunch of new residents who will not know anything about this situation. Infact I bet the ones who yelled at you do not remember. As long as the pt was ok, you are fine. Keep your chin up!!!!!!