question about insulin, heparin injections

button2cute · Aug 28, 2005

OMG, Buttons!
Wow! What a horrific experience! I can not believe they actually let you go home w/a clot that size, especially after apparrent "med errors", and the possible repurcussions of what happenned. Also, let this be a lesson to any patient....you have the right to refuse a medication. If you told them you had already received the heparin, and they "acted as if you were lying" and gave it anyway ??? Wow! I have pt's refuse meds/treatments all the time.... I'm glad everything turned out allright, sorry you had such a bad experience.

Hello, Moon

Yes, they made a decision of not to place an incision. They did not want to cause more harm to me. I was not a happy camper because I had to swing my my legs to walk. So, I had learned from their error to double check.

The incision would had to be packed five times a day, Washed out,place antiboics, and hot compresses. The gyn stated that the clot will break and then it has to be clean out. It was too much for me to deal and to understand way too much information on how to deal with the incision. They allow mother nature to take her course. Therefore, I would never want anyone to experience the pain and the blood clot.

Buttons

BETSRN · Aug 28, 2005

I'm doing lab right now on injections and we are being taught that when we draw up heparin or insulin we have to go to another nurse and have the dose and med confirmed. I have never seen that done where I work. In fact, there is only one nurse per unit so it's not possible that it could be done. Do you practicing nurses out there do that?

It's always been policy where I work to have two nurses check insulins: not too sure about heparin. However, I always check it with another.

BETSRN · Aug 28, 2005

Hello, All
I agree with the "double check" policy, regardless, if a hospital requires it or not. Heparin is a dangerous drug if it is given incorrectly. I have learn from experience.
When I was a patient at hospital and the physician order heparian sq after my tah. Three nurses gave me the heparin and I told each of the that I had it once. they told me, I did not and I was lying. Well, I develop stomach pain, and it would not stop at all. I hit the pump and no relief. I was screaming and I could not deal with the pain. The physicians and surgeons arrived and I had developed a grapefruit size of a blood clot. They wanted to rush me to surgery, however, my blood was too thin and I was bleeding out. Finally, the decision was to let the blood clot to grow, it would stop the blood going into the abdominal cavity and have surgery later in the morning. By the time I left the hospital, the blood clot was a size of a basketball and hung down between my legs. They wanted to put a slice into the incision to relieve the pain and strecthing of the skin. The gyn told them my body would naturally open the incision to allow the blood clot out.
It did and the blood shot up into the air to the wall, on the chair and it stunk. I was rush to the er, they cleaned me out and it was painful. They squeeze, poke, and sweep out the blood clot. It was gross, foul smelling and dark blood.
I have learned my lesson about the draw up from heparin and how it can harm a patient, personally.
In conclusion, make the time for patient safety, checking the order and drawing up the medication and lastly, have someone to double check your work and it is not a trust issue, it is a safety issue for the patient and you.
Have a great evening,
Buttons

The nurse giving you the heparin told you you were lying? I find that difficult to believe. If that were the case, I would hope that you would have reported that IMMEDIATELY!

rickostrat · Aug 31, 2005

I agree fully, being a nurse with any experience, it would be unessessary to double check insulin with another nurse, forget about heparin. You should be checking it as you draw it up. I'm on a med/surge unit with a census of 40. Staffing is a big problem and we rarely have time to eat. We don't worry about every protocol, only the "Standard" ones like Blood Transfusions, checking PCA Pump settings, Heparin Gtts etc. I have already recieved nurse of the year in 2004, and believe me, if everyone says they follow all protocol then alot of bull is being tossed aroud this site.

Rick, RN NYC

pricklypear · Aug 31, 2005

I'm just wondering... does anybody think some of the things we do (like double-checking insulin) are dinosaur leftovers from nursing history? You know, like a habit that has become ritual - but really serves no useful or practical purpose anymore? I'm not saying insulin and heparin don't have the potential to cause harm if administered incorrectly, but if I cannot accurately draw up the right amount of the correct insulin without being double checked, why should I prepare ANY med or do ANYTHING at all without being monitored by somebody??? Why did I spend all that time in college, learning how to think critically? I don't have to have a witness to take digoxin, cardizem, lopressor, adenosine, calcium or any other drug out of our pyxis. We don't have protocols to double check those. A lot of us do it anyway - just to feel safe. But do we really need to go through all this for insulin or heparin, which, by the way, are easily measured in whole units??:) If we can't be trusted to do it correctly, we shouldn't be trusted to do anything.

rickostrat · Aug 31, 2005

Amen

rickostrat · Aug 31, 2005

I don't quite understand. Seems like a process problem. When meds are given they're signed off. You mentioned 3 nurses GAVE you heparin Sq. Maybe I'm misunderstanding your reply. Heparin is normally TID or BIDDid all 3 nurses for diffwerent shifts NOT give you heparin resulting in the clots. Either way I'm glad your ok!

Rick

rickostrat · Aug 31, 2005

heparin gtts are another story, they should be double checked. Where I work which is one of the largest Health systems in NY, it's even hard, although we get it done, to have another nurse witness narc wastes. My unit is like a war zone. If anyone has time like that on their unit, tell me where to send my resume

Rick

MQ Edna · Aug 31, 2005

I work at two facilities, one a hospital, and one PRN LTAC. At the hospital, it is required to have another nurse co-sign insulin, heparin, etc. Must be any combination of 2 RN's and/or LVN's. The LTAC facility I work at you don't have to have a cosigner. At the hospital we use EMAR, so you have to have the cosigner enter they're computer username and password into your screen before you can scan the patient and complete the documentation. PAIN IN THE BUTT!

MQ Edna · Aug 31, 2005

I work at two facilities, one a hospital, and one PRN LTAC. At the hospital, it is required to have another nurse co-sign insulin, heparin, etc. Must be any combination of 2 RN's and/or LVN's. The LTAC facility I work at you don't have to have a cosigner. At the hospital we use EMAR, so you have to have the cosigner enter they're computer username and password into your screen before you can scan the patient and complete the documentation. PAIN IN THE BUTT!

Let me clarify...it's late I'm sorry. We have to cosign insulin and heparin gtts! We don't give heparin SQ at the hospital (we do in LTAC). We use lovenox in the hospital which does not require a cosigner.