TPN with no filter, etc.

[Kiwi, BSN, RN]

In this thread, I my question is threefold. It involves a bag of TPN possibly being hung with no filter, a nurse that does not like new grads, and a new grad.

Last weekend I had to give report to a nurse who dislikes new grads. She especially does not like getting report from new grads. I made an attempt to write out a simple, concise report on the patient's progress through the night, and hoped that she would atleast discuss the most important aspects with me. I had gotten through the CV report, i.e. pt started on Hep, doppler studies shows multiple UE DVTs, cold hands bilaterally, D/C of PICC. All the while, she hastily said "OK...OK...OK". When I attempted to tell her that the pt's glucose was almost in the 50's, she said, "You know I don't care, don't you?" She proceeded to walk away without hearing the rest. I left my written report on top of the MAR, and sent a short e-mail to my manager about the incident. This had happened to me before, and I had swallowed it up - but I knew that this was a matter of patient safety.

Today I called the unit and spoke to one of my preceptors who told me that last night, some nurses were talking about me; about how I didn't put the filter on the TPN tubing. The nurse I mentioned above had that same patient, the same one that I didn't give the report to. I told my preceptor that I had written an e-mail to my manager. He said that this is her way of "getting me back". He said he didn't know if it was a "big deal" or not. I always prime TPN at the nurses station, and take the filter off there too. I honestly do not recall not hanging the filter.

If I am called in to speak to my manager, what should I expect to be done against me? Is it dangerous to the pt if some of the TPN has been delivered without a filter? Should I mention that it is ironic that I always prime TPN with the filter at the nurses station, and that I had written an e-mail about this nurse (who reported me)?

Thanks for your insight!

[mozartthebear]

sounds like a stressful situation. I'm not sure that I can really offer much concrete advice. The only TPN I worked with had a filter attached already to the tubing. It is important to have a filter just to make sure there is no way that any air can get into the line....but I pretty much can gauruntee you that if the patient is fine, then you wont get in to too much trouble. Being a student can be so frustrating, especially when you have to work with nurses that are hostile. Here are a few thoughts for you. One: we all make mistakes. I remember as a student, I ran an entire 1000 ml bag of IV fluid into my patient in about an hour (his iv was positional and when he turned in his sleep, the entire bag of fluids were delivered). When he woke up in to morning he was wondering why his arm tingled. I also hung an antibiotic but forgot to start the piggyback, so the dose was missed. At the time we feel like we are the worst nurse ever, but it's not true. We all make mistakes at some point. All you can do is learn from it and forgive yourself. You will be a great nurse. I can tell because you care (unlike some other nurses you've experienced). secondly.....it is so much easier afer you finish school. Nursing school is not nursing. Take care and God bless.

[hrtprncss]

Ether...It won't go anywhere...Technically you wrote a letter before she said anything. Therefore because it's one of those ''her words against yours'' situation, then she would look like she was doing this out of spite. You do have leverage in this situation, unless she called another nurse in the room and showed to the other nurse that there's no filter in the line. Even so, it can still be thought of as her trying to get back at you. This is given if she was approached by the manager already because of your letter. Anyways the patient was fine so no harm done. Don't worry about it.

[papawjohn]

Hey Ether

Don't some nasty people find wretched ways to spread the misery they must feel inside about themselves? They select as targets those who they figure are the most vulnerable. What a shame that today that's you.

First of all, you should learn from that nurse's mistakes and NEVER imagine that you already know what the nurse giving you report is going to say. Always assume you can learn something important from the previous shift.

Second, we all make mistakes involving IV hardware. I've been in this strange career for 25yrs, just the other night I found that I'd hung an IV piggyback and NEVER OPENED THE CLAMP. Whoops!!!

If you're called on it, admit you can make a mistake--and learn from the mistake. And you should always check that filter from now on. Just like I check that d##m clamp from now on.

You're gonna make beautiful music in your nursing career. Taking a Pt thru a 12hr adventure is like a concert. One wrong note won't offend Mozart.

Best to ya

Papaw John

[Kiwi, BSN, RN]

Thanks guys, I feel a lot better. I think I'll get to sleep tonight after all:)

[caroladybelle, BSN, RN]

I have seen TPN hanging, without a filter, or with the wrong filter, a number of times. Since TPN should always be on a pump, which monitors for air/large particlate matter, it is rarely a problem. And as you are a new grad, there should be some leeway expected.

Glucoses in the 50's on a TPN patient are a much bigger concern, as are coworkers with bad attitudes, tit for tat behavior and that spread around stories about errors to several coworkers rather than merely telling you and the the few parties that need to know.

[Tweety, BSN, RN]

Good luck.

My only advice is yes, talk to the manager and let her be aware of the situation with this nurse and report.

Next, if she does this again, and she will, don't "swallow it up", don't email your manager. Confront her. Practice now how you will respond in a mature and professional mannner. Maybe next time you start report you might say "I realize I'm a new grad and may be giving what you consider to be a way too thorough report full of trivial information, however, I would appreciate it if stick with me and not leave."

If she leaves follow her with a polite "excuse me, I'm not finished with report".

Don't respond with silence and don't report behind her back. Deal with her face to face.

[Rachael, RN]

I work at a Pediatric hospital and I can tell you Always use a filter. A filter is used to ensure no residue goes through the line into the patients bloodstream. I worked last night and one of my patients had TPN that had been hanging for 20 hours with no filter. I checked the line and got blood return. I hung my bag w/ a filter. Then i sent a incidental report into the department. Hanging tpn w/out a filter is dangerous. Not to mention when i went to draw my 4 am labs the picc line had no blood return and needed TPA. I feel this line was clogged from the tpn running w/out a filter. The line was heplocked when i started mine so probably the 100 unit heparin helped the line stay open for a little while. Then when the tpn was re started it clogged / formed a fibrin sheath.