Firewood

Hello, Today I had a patient that I was placing an IV in. I got in, got a blood return and started to push the cannula in, but hit a valve. The needle was in the cannula but not all the way, so I pulled the cannula back over the needle and tried to maneuver it (Looking back I know that this is not appropriate practice...). Well I kind of freaked out and pulled the whole thing out of the patient. I immediately looked at the cannula and it did not appear sheared off; it was the same length as a normal one. I am still freaking out because I started thinking that maybe I scraped a sliver of the inner cannula out or cut of a miniscule amount at the end of the catheter or cut a slice off the end and didn't notice. I feel very guilty! Don't know what to do...

Aren't the post endo vital signs mainly for the purpose of anesthesia recovery? Not so much for blood loss? Also, isn't a bleed outside the colon into the peritoneum (so blood loss wouldn't be noticable) from a colonoscopy super rare? Not talking about a perforation, just blunt trauma or maneuvering of the scope?

I'm new to endo, so I was more worried about an extra colonic bleed that you can't see.

No problem! Happy to add my 2 cents for what it's worth...you have to protect yourself and your license!

Hello, I've never worked in a skilled nursing facility, everything I've done has been hospital. But 1 nurse on days and none on nights for 80 pts seems dangerous. Sounds like you would be responsible if something bad happens. I wouldn't do it, sounds sketchy to me...

The other day I was working post endo and I realized that the BP wasn't set to go off after the fact that the pt was discharged. It read 130/60 3 times so in essence, in 30 minutes I got 1 BP as it must not have been set for q 15. The pt was feeling fine on discharge yet my conscience got the best of me and I notified the GI doctor a few days later and he said he wasn't worried, that he spoke with her and was fine. Then I called him again and asked if she could be internally bleeding and he said no. Then later, like, 2 weeks post procedure I called him again and asked him since I didn't get a full set of BPs and maybe she is bleeding extra colonically should we get an H&H and he said no she is fine. Now I wonder if I should of asked him if we should get another BP (which would require calling her in) but I think that would push him over the edge...But I just can't stop thinking about it! Please Help!

Thanks for the response JKL33. I wonder if others have noticed this before or am I the only dweeb who does...

I just noticed something the other day that I never paid attention to before. Here's a fabricated example of what I saw on a pt discharge from the hospital to ECF form that has me perplexed: Call Dr Feelgood's office in a couple days for an appointment in 3 weeks Date scheduled 11/13/21 @1120 AM Call Dr Goodbar's office for an appointment in 2 weeks Date scheduled 11/13/21 @1121 AM Well, the discharge time was 11/13/21 @ 1300. There was no concierge service and I believe it was auto filled by the computer, but why? Is it a time stamp/reference point so that the nursing home staff can tell when the order was written? I noticed it on other discharge forms also...It makes it look like it was already scheduled but if you read it you know it was impossible!

I had a GIB pt the other day who had a hx of CKD. His creatinine and BUN were normal. His Gfr was >60. His uop for the shift was ~ 1000cc. He had an IV of NS at 100cc/hr and his 24 hr total was positive ~1.5 L. My question is that how much does intake factor in to ckd with these lab values? If uop remains at a decent constant and the lab values are normal, can the pt be positive this much and not be considered to be renal impaired?

Thank you toomuchbaloney, you are right. After letting go, I feel much better.

Hello. I had a pt last week on a protonix gtt, 80mg/500cc at 52cc/hr or 8mg/hr. per order per protocol. I inadvertantly hung a second Protonix gtt at 130cc/hr. (80mg/500cc). By the time I caught the error I estimate that about 48mg extra protonix was transfused. I immediatley took down the second bag. I called the attending ICU Doctor in charge of the pts care and told him of the error. He said it "shouldn't have harmed the pt". I asked him if I should dicontinue the first drip of protonix since the extra amount was given, and he said "no, continue the drip". I next called the nursing supervisor per policy and then the med error hotline. I was shook up, but ok, I followed procedure. The next day I went online reading articles about protonix and how it could cause liver problems and renal problems, etc. This got me scared. I began to wonder if further testing needed to be done? Maybe I should have told the GI Doctor since he probably started the drip? I keep thinking of that pt getting worse as time goes on. But I did tell someone! I told the ICU attending Doctor! Why is that fact lost on me? Well, I feel it would be foolish and undermining to go back a say something now, but my obsessive thinking won't let it go! Even though I've been told by several others that I followed protocol and should drop it. How do I ease my mind? Did I do the moral thing?