Worried about giving wrong saline!

Penelope_Pitstop, BSN, RN · May 2, 2017

If her shock was caused by sepsis, then IV fluids had nothing to do with it. She had an overwhelming infection - I'm sure you know this, deep down.

This is a medication error, though. One I'm sure you won't be making again.

NICUmiiki, DNP, NP · May 2, 2017

This should be written as an incident report. And a responsible manager will educate you, but will also look for the system failure.

Potential system solutions:

1. Scan the fluid into the patient's MAR before hanging (hard to believe this isn't implemented in your facility already)

2. Have a second nurse compare the fluid with the order (this can be done on your own in the future, and should probably be encouraged of at least new nurses)

Otherwise, you've learned a lesson, and you'll remember it. And when you're an experienced nurse, you'll probably teach new nurses to avoid this mistake.

meanmaryjean, DNP, RN · May 2, 2017

If 50mL of the wrong saline concentration is enough to cause shock- there would be a LOT more dead people than there currently are.

This apparently scared you enough to make an impression- which is good. But learn from it and move on.

~Mi Vida Loca~RN, ASN, RN · May 2, 2017

Even if she would have given the entire bag and not just 50mL, that would NOT have sent your patient into septic shock. The treatment for shock is fluid. For Septic you will get varied opinions, but a lot of research has shown LR to be very effective. But your 1/2 normal saline 50 mL (whopping 5 flushes) did not drop your patients BP nor did it send them into septic shock. If they were heading into septic shock the fluid you hung would have been better than nothing.

That said, always double check what your giving. Depending on the system you guys use it can be easy for some wrong bags of fluid to get mixed in. 1/2 NS is as mild of a mistake on wrong fluid as you can get.

Usually fluid with K will be marked different so easier to spot, same with heparin. But D5 etc. can easily get thrown in the wrong batch too and depending on the patient, that can cause more adverse side effects.

Here.I.Stand, BSN, RN · May 2, 2017

Unless you dipped the tubing connector in E. coli prior to starting the fluids, you did not cause this pt to go into septic shock.

Had the pt gone hours and hours with 0.45% vs 0.9%, it could have lowered the pt's sodium or chloride level. Or, if he'd gone hours and hours with it at 50 ml/hr when it was ordered at 150 ml/hr, it could possibly have impacted his BP. But your mistake wouldn't have impacted him at all.

In the future, treat your IV fluids like any other med and check your Rights. Miiki ^^^^ mentioned systems issues; a couple of times, I've found our central supply staff stocked IV fluids on the wrong shelf. Like, where we ordinarily keep D5/NS+KCl, they put D5/HNS+KCl.

I'm pretty sure you won't do this again. :)

YoutubeTheNP · May 2, 2017

You definitely are a worry wort. What is septic shock? (Rhetorical). It isn't caused by saline administration. Lol. This post really made me chuckle. Read up on septic shock so you know what causes it, symptoms, and especially the treatment.

nurselalou · May 2, 2017

Thanks for all the replies... I realized the .45% didn't put her into septic shock but after her b/p dropped (prior to any blood cultures which I don't know the results of) Dr. thought she was in septic shock ( and maybe she was because her pressure dropped to approx 82/50 ( She had fever and elevated pulse already)Then her pressure dropped... around the same time I gave the 1/2 NS. It dropped to 82/50, we then bolused 2L and it slightly went up. I just have such a hard time remembering how the solutions work... SOO I guess I'm wondering if it would drop her pressure?

nurselalou · May 3, 2017

Thank you for the reply. I feel like I wasn't clear enough. I understand the solution didn't put her into shock, I'm worried that I dropped her blood pressure. It was 118/70ish and then dropped to 86/54ish. Dr. thought AFTER the b/p dropped that it was septic shock and ordered blood cultures/lactic acid, 2L bolus NS etc. Pressure went up a bit but not entirely... so she may have been in septic shock and the .45 saline I gave had nothing to do with that... just curious if it's possible that it could've dropped it? Thanks!!

~Mi Vida Loca~RN, ASN, RN · May 3, 2017

You hanging 1/2 NS to 9% NS at the same rate (I am assuming bolus) should not have impacted the BP in a negative way. Like had you ran the whole bolus over 20-30 mins and didn't notice the error until after, the 1/2 should have yielded the same BP results had it been 9%. In that scenario.

nurselalou · May 3, 2017

You hanging 1/2 NS to 9% NS at the same rate (I am assuming bolus) should not have impacted the BP in a negative way. Like had you ran the whole bolus over 20-30 mins and didn't notice the error until after, the 1/2 should have yielded the same BP results had it been 9%. In that scenario.

Thank you!!

NuGuyNurse2b · May 3, 2017

In the future, treat your IV fluids like any other med and check your Rights. Miiki ^^^^ mentioned systems issues; a couple of times, I've found our central supply staff stocked IV fluids on the wrong shelf. Like, where we ordinarily keep D5/NS+KCl, they put D5/HNS+KCl.
I'm pretty sure you won't do this again. :)

We get the exact same problem in our supply room! Unfortunately it's caused by the poor organization (if it were up to me, we'd have an abundance of NS and not the same amount as the rest of the fluids, and it'd be on the top shelf where it's easily accessible). Cause what this creates is a scenario where someone picks up the wrong fluid and then chucks it into the nearest bin, so the next person who grabs it blindly walks out with the wrong fluid. Like me. And I've scanned the wrong IV fluid bag and our system didn't even flag it!