Last night was my first night on my own. I was put in the ICU w/ two patients. One of my patients was a respiratory failure old man and the other a 20 yo female w/ encephalitis secondary to teratoma.
My old man has two peripheral IV lines. One on the right hand and the other on the left. No central line. Around 11pm last night, as I was about to draw blood from him, i noticed that his Left hand was starting to get swollen/puffy. I immediately stopped the infusion and switched his Ativan Drip and IVF tubings to the peripheral IV on the Right hand which was patent at that time. I called the doctor, told her about the situation and that WE NEED A LINE. With all these harsh medications to the vein, a central line is a MUST.
She told me “It’s okay, just put it on the other peripheral IV”. I said, okay..so i did. she even told me to increase the infusion (which i should’ve questioned).
Around 2, i checked on my patient and he was still doing okay. I decided to do my bath early for my other patient At 3ish in the morning, as the respiratory therapists were doing their ABG blood draws, we noticed that that my old man’s right hand was swollen, purple and firm. It looked really bad. I immediately stopped the infusion, put a warm compress on it and told my charge RN.
I called the doctor again and told her “WE NEED A LINE”, the hand was infiltrated and i did this, and that.
She said, keep trying to find one and if we can’t find one, we’ll put a line on him in the morning.
So i told our charge RN again, then one of the other older nurses said “Lemme try to find a good vein”. As she was trying to start a line, she flipped the right arm and to our shock found a pool of blisters. it was gross. and it looks like it hurts! It looked so awful. I checked the pulses and it was there. I went to the phone again and told the doctor about the worsening condition of the right arm. She came and evaluated the patient.
LONG STORY short, it was IV infiltration gone REALLY BAD. my pt developed non traumatic compartment syndrome. AND I FELT RESPONSIBLE. :(
She told me “It’s okay, just put it on the other peripheral IV”. I said, okay..so i did. she even told me to increase the infusion (which i should’ve questioned).
Around 2, i checked on my patient and he was still doing okay. I decided to do my bath early for my other patient At 3ish in the morning, as the respiratory therapists were doing their ABG blood draws, we noticed that that my old man’s right hand was swollen, purple and firm. It looked really bad. I immediately stopped the infusion, put a warm compress on it and told my charge RN.
I called the doctor again and told her “WE NEED A LINE”, the hand was infiltrated and i did this, and that.
She said, keep trying to find one and if we can’t find one, we’ll put a line on him in the morning.
So i told our charge RN again, then one of the other older nurses said “Lemme try to find a good vein”. As she was trying to start a line, she flipped the right arm and to our shock found a pool of blisters. it was gross. and it looks like it hurts! It looked so awful. I checked the pulses and it was there. I went to the phone again and told the doctor about the worsening condition of the right arm. She came and evaluated the patient.
LONG STORY short, it was IV infiltration gone REALLY BAD. my pt developed non traumatic compartment syndrome. AND I FELT RESPONSIBLE. :(
The thing is, he was doing good for me, we were going to extubate him that morning. His fever has gone down. His vital signs were stable. BUT Now, he’s going to the OR to get a fasciotomy.. they have to open his arms to take the fluid out. To make me feel better, the doctor said “Thanks for catching it early”. Other RNs in our unit told me “You did the right thing”. “You are a good nurse”.
All those things can be true. but whether true or not.. It didn’t change the way i felt after seeing his poor infiltrated arm. I felt really horrible. All i can think of is that I could’ve caught it earlier. i keep beating myself up about it.
All those things can be true. but whether true or not.. It didn’t change the way i felt after seeing his poor infiltrated arm. I felt really horrible. All i can think of is that I could’ve caught it earlier. i keep beating myself up about it.
As nurses, we always think that we can save people. It reminded me of this quote:
"We all do our jobs with the belief that we are invincible. That is not true, of course, but being shown our inability to save every life hits hard. Eventually the belief in invincibility comes back, because how on earth could you do this job without it?”
I went home, crying. It might seem like it’s not a big deal for someone.. He didn’t die, but the possibility of losing his right arm is there. And it hurts me. That night when i was taking the report from day shift RN, his pleasant wife and daughter was there saying hi to me and telling me how much they want to bring her husband, her dad back to LA (because they live out of town). Now, i don’t even know if i can face them when i go back to the unit tonight.
No matter how horrible i feel, i know i can’t really do anything with situations like this. It happens. What matters is how i reacted to it.. and how this experience can make me a better nurse
. I feel like I will be an IV NAZI from now on…
. I feel like I will be an IV NAZI from now on…
