Worried...did not clamp main IV line.

steelcityrn, RN · Feb 28, 2011

Will the PCA allow a bolus ? My feelings are the medication probably was trapped in the line, only to be given as the pump is set.

chancie · Feb 28, 2011

Our PCA pumps do allow programed bolus doses and loading doses. But I'm just worried that the action of screwing the new syringe into the line, and replacing it into the actual pump may have caused some of the medication to flow into the line and then into the patient. does that make any sense?

steelcityrn, RN · Feb 28, 2011

I can only see a problem if the pca pump was opened and the tubing disturbed.

chancie · Feb 28, 2011

hmmm, ok. i mean, i did have to open the actual pca pump to replace the syringe. basically, i opened the pump with the key, unscrewed the old syringe from the tubing, screwed in the new syringe into the iv tubing, and then replaced the new syringe in the pump (made sure it was in the correct position, continued my settings, closed door, locked pump, etc). but i failed to clamp my iv tubing. i made sure not to press down on the syringe, but i'm nervous some make have been infused to the patient with this process anyway. so in that sense, yes the pca pump was opening and the tubing was handled to replace the syringe.....ahhhh! i appreciate your feedback!

Esme12, ASN, BSN, RN · Feb 28, 2011

SOme PCA pumps have a built in saftey device that you actually have to unclamp the tubing once it is removed from the pump to bolus the patient. The patient would have already shown a problem as IV drugs take immediate effect. YOu need to take immediate corrective action and remember to always clam your tubing. Becomming lax in procedure leads to mistakes and harm. You should talk with your manager in private about your fears and get to know the pump better. It would be difficult to write an incident report as you aren't sure an incident occured. Learn your policy on PCA pumps....make a cheat sheet ifyou have too..........Please Be Careful!!! xo

To err is human........to learn from it....DEVINE! (a little literary humor) :)

canchaser, BSN, RN · Feb 28, 2011

It's a syringe right??? How does a syringe infuse without pressure to infuse? I dont see how forgetting to clamp the IV tubing might have caused incidental infusion.

classicdame, MSN, EdD · Feb 28, 2011

I believe there are safety features built in to the PCA pumps. I so wish everyone was beyond making mistakes---but then who would be MY nurse? Afraid there would be few nurses left

chancie · Feb 28, 2011

Thanks for the responses everyone. I am a pretty new RN, started in the ICU, and still getting the hang of things. I am also a HUGE worrier . This was not a matter of becoming lax in practice, just learning the ropes still. However, I will also remember to clamp my lines. :) And yes, it was a syringe being loaded into the pump, and since I did not press down on the syringe I'm hoping none of the medication went into the line when it was changed. However, I can see how some pressure could have been applied when the syringe was changed. So yeah, I just got nervous about it. As I said, patient was stable when I left.

I appreciate the reassurance. I like to think that all my worrying helps me stay more aware and on top of things. I don't ever want to get too comfortable in my practice, esp in an ICU. So thank you everyone. :)

CRNI(R) · Feb 28, 2011

When in doubt about anything "mechanical" possibly harming your patient...look to your patient for the answer. I worked with a nurse anesthetist who caused a patient permanent brain damage because she was looking at her monitors and not at the patient. The monitors were not showing that the patient was suffering hypoxia and she failed to catch it before the damage was done. :eek:

Sounds like your patient was stable and not overly sedated when you left with plenty of time for them to have shown you otherwise.

AnnieOaklyRN, BSN, RN, EMT-P · Mar 1, 2011

most IV tubing has a built in fi.ter to prevent backpriming if that is what you mean. I wouldnt worry about it.

EDrunnerRN · Mar 1, 2011

Never worked the PCA pumps as I am an ER nurse but how much could you have really gave him just by adding a little pressure 2 mg? Its an IV medication so you would have seen pretty immediate changes in VS if you really gave him a big bolus. Now ya got me interested in how these things work...might take a trip to the ICU tomorrow...