On July 25 NOC shift we had a bad case of infiltrated IV case that is now being investigated by the management. The resident was on continuous D5 ½ NS +10 KCL for dehydration, was assigned for another nurse, LVN. At the report time the out coming RN told me that I have a new IV bag to hang (me being only RN at night). After midnight on the way to another station I stopped in the room to check when I need to come back to hang another bag. There was more then 250 cc left in the bag, so knowing it is running at 50ml/hr I wrote myself note to come back in about 4 hours. I did not assess this resident at that time since it was not my resident. I did look at the arm with IV site, it did not look swollen or red, and the IV was running without problem. But then again, it wasn't really thorough assessment.
Shortly after 1, the LVN assigned to that resident told me, you have an IV bag that you would have to hang later. She asked me to take a look at the site. I said that I already did and it looked fine. AT around 4 am my coworker called me to the resident room. The IV had infiltrated and the arm now was swollen to the shoulder and was oozing with fluids. We stopped the infusion, elevated the arm and applied warm compress to the arm. The resident had no signs of any distress. I did assessment for the integrity of circulation in the arm. All fine. I did not start new iv at that time. TO tell the truth, me being a new grad and never until that point started IV at the facility (The residents usually get to us with PICC lines or the rare PIV that I came across during my 5 month of work started during day shifts) I was really sure that I would not be successful to start IV on my own and did not want to subject the resident to being guinea pig for my practice (Last time I started IV s was in nursing school more then a year and a half ago). The LVN who was assigned to that resident did not think to restart IV either exactly for the same reason (she is IV certified). There was only one more nurse in the building and he was really busy and said it would be bad time now. So we made sure the resident is stable and continued with our med pass.
I have a very nice ADON, I have asked her many questions in the past and she was always great resource to me new nurse. She always said, if you have any questions don't hesitate to call me at any time of the night. So I insisted my college call her, just in case I missed something. She did and ADON said to try to reinsert IV any way. I did, and got in first try! That IV hydration that she got before must really have helped. I checked with new bag against the MAR (which did not have stop day. Should have alarmed me) and hanged it.
Next day my DON called me to the office. (july 26th). She said that IV infiltration probably had started long ago before 4 am and that would I assess the arm, I would catch it earlier. Truth. I felt the same way. I looked briefly, I did not properly assessed. And then the order was only for one bag. Truth again. I did not check the physician order, I only looked in MAR. I learned a lot during that meeting, but I definitely did not feel that I might be in a real trouble. The DON said that she would like to follow up with me and we set up to meet on Monday after I finish report. She called on Monday to say that she cant make it on time and that I should go home to rest after the night. We rescheduled for next day, again after I finish report. Tuesday, she called again and rescheduled for Friday. Today, I saw her coming early and going straight to the business office. That scared me so much. I heard stories of nurses getting checks at the time they are fired.( When I got to DON office, she said again she did not have time for me, and would like to set up a proper meeting. She said she will call. All this anticipation is making me very scared. I am afraid they are building a case against me and would fire me.
It gets even more complicated than that. It was not the first time I got written up. I got written up the very first night on my own after orientation. I made a med error. (no harm done ) it is a very busy sub acute center and I was having hard time. But don't get me wrong, I accept whole responsibility and really did learn from it and really check against the MAR my meds.
So do you think it is still possible that they would let me work more than a week after the incident and still fire? Any advice how to handle my self during the meeting (whenever that will be)
Why are you responsible for an LVN that is certified in IV's? It is her responsibility.
They are running on a skeleton staff, because their bottom line is PROFIT.
Don't let them make you responsible for the entire unit, because they are cheap.
Infiltrated IV's happen all the time.You treated it properly.
There is no way we can check orders to the MAR for each med/IV. Whoever transcribed the order made the mistake. It should have been clearly indicated on the MAR that only one bag was ordered.
Highly doubt they are going to fire you, they're too busy using and abusing you.
All IV orders should be verified, period. All questionable meds verified, new meds, unusual meds, unusual doses. RN DOES hold the higher scope of practice. There were 3 nurses (LPN failed patient assessment, RN did her assessment late and 3rd nurse "too busy"). Infiltrated IV's do happen a lot, but it was to the shoulder, thats a long infiltration time. What nurse doesn't have time to check? The mistake was that these nurses didn't read the original order as she said there was no stop date, so...one should have called MD for clarification. 3 wrongs don't make a right. Best advice out there? Never believe another nurse verbally, always check written IV orders.
If she was going to fire you for this, she would definately have met with you already. Try your best not to worry about it. It is a lesson learned that you will never forget.
pixie120
256 Posts
All IV orders should be verified, period. All questionable meds verified, new meds, unusual meds, unusual doses. RN DOES hold the higher scope of practice. There were 3 nurses (LPN failed patient assessment, RN did her assessment late and 3rd nurse "too busy"). Infiltrated IV's do happen a lot, but it was to the shoulder, thats a long infiltration time. What nurse doesn't have time to check? The mistake was that these nurses didn't read the original order as she said there was no stop date, so...one should have called MD for clarification. 3 wrongs don't make a right. Best advice out there? Never believe another nurse verbally, always check written IV orders.