I recently started a job in a clinic and only have been a RN for almost a year and had a question. I have not worked in the hospital and only start IV's in the clinic a few times... but today we had a patient that was getting vanco IV. In the past the provider made us give the vanco via gravity, so today I went and borrowed a pump from a different department because I read that you HAVE to give vanco via infusion pump for patient safety. I also talked to another nurse that I borrowed the pump from about certain standards of giving vanco she said we usually have a primary line going and piggy back the vanco 1 gram in 250mL of normal saline and infuse at 167mL hour (1.5 hours).
So I got the pump ready and the provider ordering the Vanco was mad I got the pump and said "you should just be able to look at it and know how fast it is going, if you have any problems with that pump don't ask me for help because I do not use them." He also wanted me to mixed that 1 gram of vanco in only 50ml normal saline? And I had a protocol for our facility that said it has to be mixed in 250mL of normal saline. I told the provider I did not feel comfortable giving the vanco without the pump because "i cannot judge how fast it is going." and that the standard was suppose to be 250 mL. He said okay whatever mix it in 250mL of saline. So the dr had me start the primary line by gravity and once I got the vanco mixed he told me to stop the primary infusion and just infuse the 1 gram vanco(in 250mL) over at least 1 hour. After 1 hour it was not infused all the way because the pump was set at 167mL an hour he said please disconnect from pump and I want the rest ran through gravity and he set drip factor (which was wide open because he said it was not going fast enough)
1st question- was it wrong telling him I wanted to use pump because I did not feel comfortable, it felt safer for me and the patient
2nd- can you give vanco just through a primary line without piggy backing? (because he told me to stop it and just do the vanco)
This just made me feel very uncomfortable today and need some advice because I am not around this stuff everyday. I am also looking for another job because I believe I should not be treated this way when I am trying to keep my patient safe and my license. I also documented everything he told me to do step by step, to cover me. Please be kind :)
