I had an IV infiltrate a few months ago. It was pretty bad... it was regular fluids (no additives) in a 2 year old, going at 40, and his little arm did get very puffy. He was asleep when I found it. When I found it, I DC'd the IV, gave him Motrin almost immediately, elevated and hot packed it.
I then called the doc. I was really upset about it, of course... I felt just horrible! Let him know what was going on, got an order not to restart, etc.
About an hour after finding the IV and giving the motrin, the kid was still just SCREAMING... would not calm down, severe pain, etc. Had been like this since I had woken him up when checking the IV. So, for an hour nonstop this kid was acting as though he was in the worst pain of his little life. I had been in the room changing warm packs pretty often, and the arm was just the biggest infiltrate I had seen. Circulation... cap refill was adequate and so was his distal pulse. But his severe, SEVERE pain really worried me. So, I called again. For two reasons. The severe pain was worrying me... I was worried about almost compartment syndrome like symptoms. I was afraid that something severe might have to be done to relieve the pressure. I also wondered if maybe there was something I could give him assist in easing the pain.
Well, the nurse I was with was like... "Don't call! He doesn't need to know the kid is hurting. He's not going to give you anything for pain anyway." I felt pretty strongly about it, however, and went ahead and called. No, I didn't get an order for any more meds. But I did really want him to know about the symptoms the kid was having.
Anyway, I don't think I'll ever hear the end of it. It's gotten to the point where I don't want to call anybody at all over anything. But, I would much rather call than have him come in in the AM and start asking why I didn't call - or worse - something happen to the kid and me be held liable because I neglected to tell the doc!
So, would you have called the second time? I'd really like some feedback.
I think you did the right thing. I definetly would have notified the MD over something like that. If you feel something isn't right then call several times to update him if the patient is getting worse. If you didn't call and something happend it may end up in court. It is your license and it is your job to look out for the patient. The doctor appreciates it even if he acts agitated by getting called. I wouldn't let anybody else stir your judgement away from what you think is right. Your looking out for the patient.
IndyRN
2 Posts