Worried...did not clamp main IV line.

[chancie]

Hi there, ok I'm pretty worried about this so here goes.... my patient was on a dilaudid pca, and I realized after my shift the other day that when I changed out the syringe i did not clamp the iv line. thus i'm afraid i may have bolus dosed my patient when i put the new syringe in.... i changed the syringe about an hour and half before i left for the night, and basically i'm just worried something may have happened. what if i did bolus them? the patient was sleeping, but arousable when i left, vitals stable. but i'm still worried. i will always be more careful in the future. just looking for a little reassurance. thanks.

[CCL RN, RN]

Don't worry. You would have to push down on the syringe to give any kind of bolus. Do you not have a second RN do syringe changes with you?

Although this was an isolated event (hopefully), just get into the habit of always clamping lines when you are changing syringes, pumps, etc. For regular tubing, You don't want to change an insulin gtt, or levophed gtt over to another pump and accidentally bolus that.

And for all who say there is a built in latch to prevent accidental boluses, at least on regular alaris tubing, I have seen that fail. (I do realize we are talking about PCAs here, but I wanted to emphasize that we can't always rely in back up measures..)

So, especially in the ICU, get used to clamping...

[MunoRN, RN]

You are correct that it is possible for the PCA med in the tubing to free-flow when disconnected from the syringe since there is no upstream closed system, although it's unlikely. The PCA tubing we use has no clamp on it, what I do is to stop the fluids I have the PCA running in to while I change the syringe, which is probably a good habit, but in the time it takes to change the syringe it's unlikely that a large amount could infuse. Even if the whole line were to empty (and I've never seen it flow even a tiny bit), the tubing we use has a volume of only 0.2ml