Syringe Disaster

[LibraNurse27, BSN, RN]

Hi all, I am having a mental health crisis and had to take a few weeks off work to stabilize, and feel I'm not able to accurately evaluate the seriousness of situations in my current state. I changed jobs 9 months ago and had trouble finding a psychiatrist with my new insurance, and ran out of my meds for bipolar 1. After a few days off meds I felt disoriented and experienced trouble focusing, even some visual hallucinations.

These symptoms became increasingly worse yesterday during a busy shift with short staffing. A pre-op nurse asked me to give 5000 units heparin SQ and show her how because she hadn't given a sub q since nursing school. I have given heparin hundreds of times. But I felt so out of it, I could barely figure out how to draw it up. I used a 1ml syringe that didn't have a leur lock instead of a 3ml leur lock syringe. When I gave the injection some of the heparin went in but then the syringe disconnected from the needle and the rest spilled onto the bed! The other nurse saw it but didn't say anything. The OR team was rushing her so they could bring the pt in. I told my charge nurse and she said I didn't need to tell the surgeon.

Apparently the pt had no history of blood clots but had once had a weird phlebitis of a vein in his hand that resolved on its own, all labs for a clotting disorder negative. She said anesthesia didn't think he needed heparin but surgeon did. I wanted to let the surgeon know but I was being called back to PACU because another patient was getting up unassisted and another coming out of OR with no nurse available. By the time those things were settled the heparin patient was in the OR. The rest of the shift I could barely function because I was sick with anxiety on top of my bipolar symptoms. I finished the shift but avoided giving any meds. Today I went to the ER and got my meds plus time off to find a psychiatrist. Do you think I am horrible for not telling the surgeon? I am seriously considering resigning even if I'm able to re-stabilize on medication. I don't want to be a danger to patients or become someone who doesn't own up to my mistakes. Thank you so much for reading this long post.

[JKL33]

Sorry you have been having a rough time.

We have all had situations where we wish we would have done something differently. You know what the right thing would have been here; it didn't get done and there's no use letting it eat you alive at this point. Just always go with what you know is right no matter who says what. A charge nurse certainly has no authority to give the advice she gave.

 

14 hours ago, LibraNurse27 said:

I am seriously considering resigning even if I'm able to re-stabilize on medication. I don't want to be a danger to patients or become someone who doesn't own up to my mistakes.

Just take care of yourself right now. You are a good person and you know what's right.

You are doing the right things and I hope you begin to feel better ASAP. ?

[LibraNurse27, BSN, RN]

Thank you so much for your reply @JKL33. You are very encouraging 

[londonflo]

Please take care of yourself now. I do find it odd that a surgeon would want heparin given to a patient prior to surgery. In my past work on evenings, we usually held it if surgery was the next morning. 

I have had things swirl around in my head for days, when I wished I could of done something different or done better. Take care, you did the best you could. 

[Emergent, RN]

Just take time off, eat healthy, relax, take walks, and let your meds kick in. (((Hugs)))

[LibraNurse27, BSN, RN]

2 hours ago, londonflo said:

I have had things swirl around in my head for days, when I wished I could of done something different or done better.

Ahh I am sorry that has happened to you! It's a terrible feeling. I also thought it was weird to give heparin right before surgery, and the anesthesiologist didn't want it given. If I had been more with it I might have questioned the order, but I could barely remember where I was. My friend said maybe it's good he didn't get the whole dose. But I still have it on my conscience that I made an error and didn't report it. I will try to do as @Emergent suggested, walking and waiting for the meds to work, eating salad and no skittles or starbursts allowed! LOL thank you all so much for your advice 

[Nurse Beth, MSN]

I hope you are feeling better and I have a question...I know you are concerned about reporting the leaked heparin, but did you see the surgeon's order to give it?

[LibraNurse27, BSN, RN]

2 minutes ago, Nurse Beth said:

I hope you are feeling better and I have a question...I know you are concerned about reporting the leaked heparin, but did you see the surgeon's order to give it?

Good question! Yes I did see it. Even though I was out of it and I now realize I should have gone home, I did do my 5 rights. And I had another nurse double check because I knew I couldn't trust myself that day. In my current headspace I would have asked why we were giving heparin right before surgery. At the time I was in a really bad place and even kept seeing a man who I know wasn't there in the corner of different patients' rooms. I'm feeling much better even after just 2 days off and back on medication, but I know it will be a process. 

Do you also think it was a strange order? 

[Nurse Beth, MSN]

18 minutes ago, LibraNurse27 said:

Good question! Yes I did see it. Even though I was out of it and I now realize I should have gone home, I did do my 5 rights. And I had  I'm feeling much better even after just 2 days off and back on medication, but I know it will be a process. 

Do you also think it was a strange order? 

Glad you are feeling much better! It's interesting and I have no pre-op experience, but heparin is reversible. I just googled it really quick and saw a 2015 study that said 5000 units pre-op did not increase significant post-op bleeding.

[LibraNurse27, BSN, RN]

6 minutes ago, Nurse Beth said:

I just googled it really quick and saw a 2015 study that said 5000 units pre-op did not increase significant post-op bleeding.

Interesting! I also found a study saying it's effective in preventing DVTs and PEs in high risk surgical patients but it seemed focused on patients having major surgeries. This patient was having ORIF of the wrist. It was also confusing because he didn't have a clotting disorder. The thing that made him possibly higher risk for clots was that in Jan he went to urgent care for what looked like phlebitis of a hand vein that came out of nowhere. The ultrasound was negative for any clots and all labs normal. 

While he was in surgery I looked all that up. I saw he wasn't prescribed to go home with anything to prevent clots. Maybe he didn't really need the pre-op heparin, but I'm not a doctor and shouldn't make those decisions. If I have a question about a doctor's order I can ask, and if I don't carry out the order correctly I need to report it. I am just glad to be thinking somewhat clearly again. If anyone has experienced feeling disoriented or psychosis, it is horrible, and especially at work. I won't be going back until I and a psychiatrist feel it's safe, because on top of heparin I need to be able to safely administer narcotics and monitor patients with airways, etc.

[Nurse Beth, MSN]

15 minutes ago, LibraNurse27 said:

. If anyone has experienced feeling disoriented or psychosis, it is horrible, and especially at work. 

I have not, but a loved one of mine has, and it breaks my heart whenever she has a rough spell. Best wishes, my friend

[LibraNurse27, BSN, RN]

15 minutes ago, Nurse Beth said:

Best wishes, my friend

Thank you for your kindness ?