she tried to access mediport, it was really a pacer

DutchgirlRN, ASN, RN · Jan 25, 2006

Pacer and Port can be in same location and can appear similar to the eye but Good Heavens when you feel it, you can feel the silicone septum vs hard surface! After 1 stick, the nurse should have known. Poor patient.

Darlene K. · Jan 25, 2006

nurse at work told me this horror story today,( she works per diem at another facility), was working this weekend in acute care, was called off the floor to try to access a mediport, after this other nurse tried 3 times. on arrival, she finds it wasn't a mediport at all, but a pacemaker. this other nurse had poked it with the huber 3 times, the guy was bleeding all over, apparently in critical care now. this guy never even had a mediport. Can you believe tis incompetence??!!

I hate it when that happens! :eek: Just kidding.... unbelievable:eek:

DusktilDawn · Jan 25, 2006

leahjet
ana's mommy
join date: jul 2003
location: wayyy below the mason-dixon line
posts: 255 re: she tried to access mediport, it was really a pacer
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quote:
originally posted by dusktildawn
it's not just newbies with lack of experience that may have a problem, heck, in general they're more likely to ask questions.
you know, you are so right. recent graduates will ask questions and that's a good thing. a lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. i'll admit, being a 10 year experienced nurse, when something comes up that maybe i should know about but don't.... it's kind of embarrassing but i would never risk a patient's well being for my pride.
i dont know about this. i know that new grads will ask lots and lots of questions during their orientation....but afterward....a huge huge fear of theirs that i have heard over and over again is that their coworkers will think they are "incompetent"/stupid....and so after orientation they "watch" alot but ask few questions.i am speaking from experience - i was involved with a research study that investigated "why" so many new grads left teaching hospitals in their first year of employment. this is what they said over and over....that they "feared" being perceived as incompetent ...or not being able to "handle" a situation if after orientation they routinely asked questions.
older more experienced nurses....usually ask.....bc they have seen what happens when questions are not asked. every once in a blue moon you will have some blooming idiot who doesnt. inexperience....isnt an excuse.....and if this nurse was experienced...stupidity isnt an excuse either.it sounds like this patient had alot of medical issues ...and it wasnt his first rodeo at this hospital. therfore ....he'd have a h&p on file.you dont access a port unless you know its been routinely used and flushed....and it is in their h&p that they do actually have a port a cath.ditto on the pacer.....that info was somewhere in this guys h&p. if he was that sick ( nonresponsive)....you would know it was a pacer bc he would have cardiac monitoring. bp and leads...thats one of the first things you do.it wouldve showed a paced rhythmn.and that doesnt mean you have to have someone click the "paced" box on that ekg monitor...if you are caring for cardiac monitored patients ...you should be able to easily spot a paced rhythmn for youself.
dont lose sight of what happened...when that patient entered those doors and was admitted....he / she deserved safe medical and nursing care. ive seen plenty of competent new grads that can easily reconize a paced rhythmn...and any expereinced nurse caring for this "sick" of a patient...shouldve been able to reconize it as well. now...we have placed that patient at further risk...bc....now he has to have the pacer replaced....in addition to all the other issues he has going on.

tnnurse, i would love to see the full results of your study.:)

i think the issue of being perceived incompetent/stupid because of asking questions isn't just a new grad issue. i also think the first year a person works as a new nurse is the most stressful for numerous reasons:

1. they do have a fear that they are incompetent. the transition from being a student nurse to being functioning staff nurse can be a difficult process. you go from being taught nursing as it should be and are thrust into nursing as it really is. you'll encounter so many things/situations that you were not taught how to handle in school. i think the first year nurses are the ones that will question themselves the most about their competence and whether they are cut out to be nurses.

2. the preconceived ideas and ideals we held about nursing we when we choose the profession. we all had our own reasons for choosing to enter the nursing profession and with those reasons we all had our own ideal of what a nurse was and what nursing was supposed to be. whatever that ideal was, how many of us can say that nursing has been just what we expected it would be. it can also be disillusioning. this "death of the ideal" is a loss we go through, most especially during the first year we are in the profession. it can also be a difficult process that some can't work through.

3. the work environment itself. it's not usually/never set up for a new grad just off orientation. they do still need guidance and resources they can turn to. if an experienced nurse finds their work environment stressful/difficult/overwhelming, multiply that x10 for the newbie. it's often not set up well for both the experienced nurse and the new grad. for instance, i start my 12 hour shift with 3 new nurses just off orientation and 1 nurse that was agency. so now i have 3 new nurses who will seek me out as their resource (understandable) and an agency nurse that will also seek me out as their resource (also understandable) because he/she is unfamiliar/has limited familiarity with the unit. oh yes, let's not forget i'm also charge and have a full patient load (the same as everyone else) on top of this. in a situation like that, how receptive to questions/interruptions and how supportive can an experienced nurse be? oh yeah, and how much hair did i have left at the end of that shift? :uhoh3: :crying2:

i don't doubt that in this scenario, there were questions the newbies didn't approach me with, in fact it's this type of environment that discourages them from asking questions. i also doubt they realized the impact on myself being charge on the unit with the 3 of them only because they lack the insight from my perspective. what i mean by that is, i can remember being in their shoes as once being a newbie and can empathize with that, because they are not yet on my side of the fence, it's not really possible for them to be empathic and insightful towards my position.

new nurses may fear being perceived as stupid/incompetent for routinely asking questions, i'm not saying they don't, it's another factor that adds to the stress of being a new grad. they may also watch and learn. they've also spent the last 3-4 years asking questions and learning from the "questioning/research" perspective. from my experience they do ask a lot of questions, sometimes they may not even be aware of how many times they do ask questions. it also wouldn't surprise me that for every 1 question they do ask, there may be 10 questions they refrain from asking. i'm not saying this as a put down to new grads. i expect that they will ask questions because they are still learning and want to learn. oh and btw, there are things experienced nurses can learn from new grads if they are receptive enough.

you know, you are so right. recent graduates will ask questions and that's a good thing. a lot of experienced nurses feel pressure about "looking ignorant" in front of peers and will try to muddle their way through with unfortunate results. i'll admit, being a 10 year experienced nurse, when something comes up that maybe i should know about but don't.... it's kind of embarrassing but i would never risk a patient's well being for my pride.

you know leahjet, i'm never embarassed when i ask questions. i don't see any reason to be. i will never know everything and i don't know everything. one thing i've always loved about nursing is that there is always something new to learn. i view my peers as a learning resource, as i hope they view me the same way.

UM Review RN, ASN, RN · Jan 25, 2006

Now...we have placed that patient at further risk...bc....now he has to have the pacer replaced....in addition to all the other issues he has going on.

Come again? Why does he need a pacer replacement? Unless she trashed the wires leading out of the pacer, which would actually be worse than damaging the body of the pacer itself, since the wires actually embed themselves in cardiac tissue. (A procedure which could potentially damage cardiac tissue as well as risk infection.) The pacer itself can be literally unplugged from functioning wires and replaced with a small incision. (Again, risk of infection.)

I imagined that all this could set him up for quite an infection--which could travel to and affect his heart--but I'm having trouble seeing how a couple of needle pokes could damage a pacer to that extent.

Judee Smudee, ADN, RN · Jan 25, 2006

:uhoh21: Ouch. In our instution, you have to be certified to access those ports.
On a side note, I was taking care of a pt one day. We had a chest xray done to verify line placement for a line from an outside hosp, and the doc & I are looking @ the film... what do I see? "What the hell is that?!?! A pacemaker??" The doc is like, "Oh, yeah." The day nurse never mentioned this info, the monitor was not set up for a paced pt, and it wasn't even on the flowsheet! EEEKKK!
Peace,
Sharon

The fact that patient has a pacemaker frequently is missed in report. On quite a few occasions it is not mentioned in doctors H&P or anywhere on the chart. I consider it a recurring problem. I remember having a patinet that had implantable defibulater and that did not get mentioned anywhere either. All these things are getting smaller and harder to see.

jhlynngirl · Dec 8, 2007

I am an oncology nurse. I work with mediports on a daily basis. You would be surprised how many nurses ruin my patients ports in the hospital. The incompetence is sickening to me. As a nurse, I find it liberating to admit what I do not know, and learn it.

If a nurse does not know what they are doing, ask. Leave it alone. It is not a difficult concept.

Chloe'sinNYNow · Dec 8, 2007

I am an oncology nurse. I work with mediports on a daily basis. You would be surprised how many nurses ruin my patients ports in the hospital. The incompetence is sickening to me. As a nurse, I find it liberating to admit what I do not know, and learn it.
If a nurse does not know what they are doing, ask. Leave it alone. It is not a difficult concept.

Maybe not a difficult concept jhl, but not easy to do in all places. I just quit an Onc unit b/c my questions seemed to bother. I was left on my own too often to do too many procedures because it was expected of me. I was being reminded too often that I was lacking in self-confidence b/c I aksed to be watched if I was unsure about a procedure but then they'd tell me out of the other side of their mouth that I was going too slow, or being incompetent, or lacking in this or that.

It was expected that after viewing on access/deaccess of a port that I should be able to do it afterward. yet I was still unsure of myself and so refused. Because each time (I think I saw 3 actually done) I watched it being done, the nurse doing the poking, failed the first 2 attempts, and I was told to leave the room to get someone who could do it. (I think this reads a little confusing; I never actually did the access or deaccess. I was always an observer)

And they expected THIS new grad to be able to do it just b/c it's part of being on an Oncology unit?!?!?!??!

(let me add here that I was on this unit only 3 weeks at this point. and straight out of NS too; turns out, my orientation was only supposed to go 6 weeks and at 8 I had one too many meltdowns on my own. I let them see my tears and frustration. What an embarrassing exit!! )

Chloe