New nurse made a mistake!

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Hi all,

I've been working as a nurse since July (I graduated in May 07). I started at a small community hospital ICU. I work the 7p to 7a shift and have been doing very well. Just when everything is going so well I was doing a PICC line dressing change and accidentally pulled it out a at least 4 inches (which is a LOT for a central line). The dressing was so saturated with old dried blood that the old dressing was difficult to take off, and I must have pulled it even though I was extremely careful. I immediately cleaned and dressed the site appropriately, told my charge nurse, and called the doctor to obtain a stat chest xray. Then, I gave report to the oncoming nurse who had had the patients the previous day. When I told her what had happened, she looked at me as though I had run over 2 puppydogs. I know that its a big deal, but things happen and it could have happened to anyone, right? Am I wrong to think this way? I did what I could and acted appropriately after the event. Let me know what you think.

Specializes in Cardiac Telemetry, ED.

I agree the nurse shouldn't beat her/himself up over it. It is important to understand the ramifications of our mistakes though.

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Specializes in Utilization Management.
Actually, that's not quite the case. If this is their only IV access, and it cannot be used because the tip is no longer in the SVC, then it could compromise their safety if they are in need of any kind of life saving infusion. I don't know if you've ever watched a PICC line insertion, but it is no small task, and there are risks involved. This is why patients have to sign a consent for PICC placement. It is an invasive procedure.

Technically, it might now be a Midline. Of course, you can't draw blood from it or use vesicants in it, but it might be usable, despite being pulled out 4". However, it is no longer a PICC line. Here's what the Infusion Nurses have to say about it:

http://www.mdins.net/sharedresources/venifacts/picc_vs__midline.htm

PICC stands for Peripherally Inserted Central Catheter. In other words, it is a central line that is placed via the peripheral vasculature. Midline is a shorter version of the PICC. It is inserted in the same fashion, but it terminates in the axillary veins rather than in the central circulation.

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
Technically, it might now be a Midline. Of course, you can't draw blood from it or use vesicants in it,

A midline can be used for drawing blood we do it routinely, not for tpn/vesicants.

Back to the OP, you did the right thing, mistakes happen, pt's also pull their lines out and yes, the PICC's use to be more secure when they were sutured. I had a pt pull one back once about 4cm, told the doc, she came in the room pushed it back in,checked the CXR, all was fine. Sometimes IV"s ports,anything can be dislodged in the real world. You will be aware every time you change another dsg.

Don't take the "look" too personally. This nurse just may have been projecting her thoughts of how this may inconvenience her day--(now I'll have to call the PICC nurse, reschedule her____whatever/meds,try to get a peripheral line in for now)etc. etc, some people are always like this.. They take a problem and personalize it, instead of just dealing with it. You did not do this on purpose, our days and nites are filled with problems and trouble shooting and fixing them, that's just the way it is

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Specializes in Utilization Management.
A midline can be used for drawing blood we do it routinely, not for tpn/vesicants.

Back to the OP, you did the right thing, mistakes happen, pt's also pull their lines out and yes, the PICC's use to be more secure when they were sutured. I had a pt pull one back once about 4cm, told the doc, she came in the room pushed it back in,checked the CXR, all was fine. Sometimes IV"s ports,anything can be dislodged in the real world. You will be aware every time you change another dsg.

Don't take the "look" too personally. This nurse just may have been projecting her thoughts of how this may inconvenience her day--(now I'll have to call the PICC nurse, reschedule her____whatever/meds,try to get a peripheral line in for now)etc. etc, some people are always like this.. They take a problem and personalize it, instead of just dealing with it. You did not do this on purpose, our days and nites are filled with problems and trouble shooting and fixing them, that's just the way it is

Our hospital policy is that midlines are not to be used for blood draws. So of course, you'd want to check the policy before you did anything.

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

Thanks for the reply, our policy does allow blood draws from midlines,guess I should feel lucky! Makes life for me and the pt a lot easier.

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"....even though I was extremely careful"

Apparently not careful enough. I would have most likely given you "the look" when you told me that in report. Sorry but a half an inch is a lot- stop pulling and try something else. To have pulled it out 4 or so inches is careless. Live and learn. No one is perfect and I'm sure it won't happen again soon. You did take the appropriate action which means a lot- some would have just tossed on a dressing and hoped no one would notice. By taking responsibility for your error you did the professional thing but "...it could have happened to anyone, right?" It could have happened to anyone who wasn't as careful as they should have been as I'm sure you will be in the future.

This is exactly why so many nurses leave the profession or get burned out early in their career. I cant stand bullies. This person must have forgotten what its like to be new. I agree with the majority of others. You did better than most by responsibly reporting the incident. You are on your way to becoming an excellent nurse. I have seen more mistakes that have been covered up or lied about to the point now I am terrified to be hospitalized. Thanks for being so honest about what happened to you. You could be my nurse anyday!

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Specializes in Cardiac Telemetry, ED.
Technically, it might now be a Midline. Of course, you can't draw blood from it or use vesicants in it, but it might be usable, despite being pulled out 4". However, it is no longer a PICC line.

True, but in my facility, you'd have to get a doctor's order to use it if the tip is not in the SVC.

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Specializes in Utilization Management.
True, but in my facility, you'd have to get a doctor's order to use it if the tip is not in the SVC.

That goes without saying, Nancy. :)

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"....even though I was extremely careful"

Apparently not careful enough. I would have most likely given you "the look" when you told me that in report. Sorry but a half an inch is a lot- stop pulling and try something else. To have pulled it out 4 or so inches is careless. Live and learn. No one is perfect and I'm sure it won't happen again soon. You did take the appropriate action which means a lot- some would have just tossed on a dressing and hoped no one would notice. By taking responsibility for your error you did the professional thing but "...it could have happened to anyone, right?" It could have happened to anyone who wasn't as careful as they should have been as I'm sure you will be in the future.

OUCH...

I'm sorry...but I think there are multiple issues here.

1. Why wasn't the PICC sutured or more securely fastened?

2. Why was the dressing so saturated with old blood that the PICC line was adhered to the dressing after the blood dried?

3. Why didn't the new nurse ask for assistance when the dressing change proved difficult?

The new nurse did take appropriate action after the PICC was dislodged.

Pt's can and do lose lines all the time. A few months ago I had a nurse with 25 years experience accidently pull PICC partially out when the tubing became tangled. This is one of the most professional by the book nurses I know.

As for "giving the look", IMHO, that's creating a hostile work environment...

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Specializes in Utilization Management.

As for "giving the look", IMHO, that's creating a hostile work environment...

"Giving the look" is sometimes as reflexive as the "deer in the headlights" look that new grads give off. That is, it is unable to be controlled. I know I've had that "look" sometimes myself, until I adjust to the realities of the situation.

I think to say that "the look," in and of itself, creates a hostile work environment is going a bit far. JMO.

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Specializes in Cardiac Telemetry, ED.
That goes without saying, Nancy. :)

The time between the PICC being retracted and getting the doc's order to use it is time that the patient has no IV access. That's all. That may or may not be a problem depending on the patient's condition.

As far as the look, maybe it was one of empathy. It's hard to say without getting into the other nurse's head. As long as they didn't SAY anything hostile, I'd let it go. I'm sure I've made faces (probably the "deer in the headlights" most often), and would hate for anyone to misinterpret or take it personally.

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Don't feel bad! I was making rounds with a Doctor who did the exact same thing! I am so glad he was the one who wanted to get a better look, b/c I am sure if I had removed the dressing I would of done it myself!

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