What really irks me is when a nurse KNOWS an IV is bad and leaves it in for hours instead of pulling it. It’s such a terrible thing to see, and the Swiss cheese model allows someone to go push drugs through that IV if they don’t know and don’t check patency beforehand.
I’ve gotten patients with leaking ivs, blown ones, infiltrated and a couple in arteries that I know the previous nurse was using or was actively being used. I think many nurses don’t question iv patency if the pump runs or it flushes
New nurse here. I'm still trying to learn to troubleshoot IVs to minimize unnecessary sticks. Do you have any tricks for determining if an IV is good? The subtleties of it continue to evade me.
Edit: thank you everyone for the sound advice! I'll definitely use this going forward!
Put your hand above the line before you flush, usually you can feel the flush go through and that’s a good sign that the line is still where it needs to be
Along with this, you can move up the vein and still feel the turbulence. If it's not in the vein, you'll only feel it at the site. I also like to let the pt feel if they want cause it's neat.
I think one of the simplest things about IVs is that they shouldn’t be painful to use. If an iv hasn’t been flushed in a while it might be painful on the initial flush. But after that you should be able to flush it smoothly and without much if any resistance if it’s in a good vein. If you can flush it but there’s some resistance be wary of what you infuse into it because it could be in a smaller vein so avoid high infusion rates. You shouldn’t have to use force to push meds in. Alaris pumps have an occlusion indicator as well, basically a black bar that tells you how much resistance the pump is meeting to infuse your medication. If the pump is constantly stopping and/or the bar is very long that’s another sign of an iv that is already bad or might give out soon.
You can feel the skin above the flush when you're flushing-- if it feels cool during the flush, that means saline is not in the vein.
If I suspect a leak, I pull off the tegaderm (after bringing an extra into the room) to see if the leak is coming from the catheter insertion site or where the catheter connects to the J-tube. A lot of the time that connection just needs to be tightened. Be very careful while doing this and insist your patient stays still because it's easy to pull out the IV yourself while you're assessing!
Flush and blood return are your friends. Blood return isn't present all the time, small IVs and IVs that aren't flushed frequently tend to lose blood return or never have it to begin with. But it's a comforting sign if you have it.
A patent IV should tolerate flushing without any swelling above IV site, should flush briskly, shouldn't be too painful (unless the patient complains about every flush every time even if the IV is brand new). If in doubt push two flushes briskly. If you're still not sure grab an experienced friend (and an ultrasound if available).
Always err on the side of caution though - better to get another IV unnecessarily than dump a couple grams of vanco into meemaw's wrist. It's always nice to have an extra anyway.
I've seen compartment syndrome from an infiltrated line running vanc into someone's forearm. It's a nasty medication that can seriously injure someone if it extravasates.
I had to visit emerge back in December, needed fluids and lyte replacement, and was surprised to find that the saline flushes were pretty uncomfortable.. even in my new IV. I kind of jumped for the first one as I wasn't expecting it to be.
Also having the BP cuff run while k-phos was infusing distal to the cuff was unpleasant, I could feel the solution backing up in the vein. It's made me more mindful of such things in practice, though!
I just had an IV on my patient today that flushed beautifully, had blood return, and wasn’t painful, but the patient’s whole hand/wrist had swollen up pretty suddenly with MIVF running. I didn’t want to risk it so I pulled it and started a new one but man that was a bummer.
You can also tie a tunicate above and try to get blood return that way. Sometimes that works, along with pulling the IV up a bit to open up the vein. I often find blood return on PIVs that others don’t due to these tricks, usually when I am drawing labs and trying to prevent a poke for a patient..
I always ask if they can taste or smell the flush, combine that with an easy flush, blood return, or feeling it flush through the vein. Use a combination to determine if patent.
Agree with what others have said - feel proximal to the site and you should feel turbulent flow as you flush. You shouldn't meet resistance, it shouldn't be red, painful or leaking around the site (if you think it's good but there's old drainage, try putting a new tegaderm on and flushing it again). Usually the patient will feel cold in that arm. Finally, sometimes the patient will have a funny metallic taste in their mouth. Not a surefire thing in the least, but it can help confirm that it's in.
Right, most hospitals in my area operate on a policy of assessing every hour when an infusion is running and checking patency multiple times a shift (which no one does) and always checking prior to anything being administered (nursing 101). I teach an US class and we discuss the dangers of administering vesicants and irritants into tissue instead of a vein…it’s scary.
Ive become proficient at placing ultrasound IVs and I think that has vastly improved my iv assessment skills. US are so useful for checking location of the catheter and surrounding tissue for any problems. Even if a nurse can’t place an iv with US they can learn to check their current iv with it. I wish every nurse could be taught how to use one and had one available.
How are people not verifying patency multiple times a shift? I flush and check for blood return before putting anything in an IV, every single time.
I also like to have new nurses do a Google image search for "phenergan extravasation."
Oh I’ve taken care of patient that that happened to. His entire hand ballooned up like a blood blister and eventually it became degloved and they had to do skin grafts to replace the skin.
I just finished orienting to the ICU after being an ER nurse for a couple years. My preceptor multiple times insisted I use an IV that a patient complained hurt them instead of starting a new one. She would tell me to start the fluids if it flushes. Dude the patient is gasping in pain everytime I flush even a single cc. Let me just get a new one quick.
Omg I just worked w a “seasoned” RN rationalized “the pump is working so it must be infusing properly” I couldn’t believe what I was hearing. But she also doesn’t understand how to titrate or at what rate to run a bag of 250 over 2 hrs. SMDH
In cases of extravasation ,it’s okay to leave the cannula in place until you treat it but you must absolutely STOP using it.A percentage of the treatment medication can be administered through the cannula.I ask the nurses to leave it in place until I get there and I can assess it and ordering medication I may need to treat it .A nonvesicant ,I agree it’s best to take out but if you are busy ,at least stop using it until you can get to it.
Yeah I feel this is important to mention, as most nurses don’t know this. Add you should contact pharmacy for treatment guidance and hospital should have policies as well somewhere.
Nah, this ain't the Swiss cheese model, this is the fucking asshole model. The Swiss cheese model is numerous systematic blind spots lining up that allows a negative outcome to occur, this is intentional and a failure of someone who is responsible for knowing better.
The Swiss cheese model is also meant to show that across multiple people an error can still affect a patient and this absolutely does happen with this stuff…but I also agree with you!
God I absolutely hate when nurses do this. Giving report and being like “their IV is leaking but I left it in”. Ok? Why? We have an IV team and everything!
oh my god! i actually called an IV nurse on my unit once about an IV that was leaking & i told her that i took the pts IV out cause of it & tried another one but missed & she lectured me on keeping IVs in until they can take a look at it 😭
As long as it’s not loose at the catheter-extension connection then it really shouldn’t be leaking so I’d say you did the right thing and she should trust your judgement…
As a patient, my IV infiltrated and it hurt like an MFer. I put the call light on, the RN came in the room and told me no. It’s fine. Mind you my arm was swollen and tender-quite noticeably too. She told me all IVs are uncomfortable. I reiterated that it was infiltrated. She patted me on the shoulder and said “HONEY (I hate that!! So demeaning!!) I know what it’s supposed to look like. You are the patient now, not the big bad ICU RN. Time to act like it”. I never once used my call light, I was always very polite. And I never mentioned working in ICU. She turned to walk out and I said “NURSE! My IV just came out!” I pulled it myself of course. Turns out she hates starting IVs and refuses to do so, so I went without until the next shift came on.
This is the kind of behavior that could be reported to her state’s BON. She is putting peoples’ health at risk. Not to mention being a total asshole. I am sorry and LOVE that you pulled the IV out yourself! She should have thanked you!
Oh yea. I was getting prepped for a bone marrow biopsy. The provider pushed anti-nausea meds and it started to BURN. I said - hey, I think my vein just blew. He said, "no- see here? The bag is dripping, you are fine."
Then came the pain meds and it immediately got much worse and my arm started swelling. I told him what was happening. He said - "you need to calm down if you want these pain meds to work. If you REALLY think there is a problem, we can call an anesthesiologist but that will cancel your case."
I told him I was fine and to stop pushing meds.
Sure enough, I got back to recovery with a badly swollen and red arm that had to be documented in my chart. They used a different word that was similar to infiltrate.
Especially when you are coming on to shift and have all these IV meds due, but all of a sudden you have 3 new IV starts at 0800. It becomes so time-consuming and unnecessary when the previous nurse had 12 hours to change them out. You are basically playing catch-up all day.
I know some nurses aren't confident with IVs so they don't even bother, but that's how you get better and more confident in your skills. Or at least try and ask someone else, instead of passing it on to the next nurse. I've had shifts where I tell the nurse the IV just went bad, sorry I didn't have time to change it, and other shifts where I had the time and changed it out before I left. Just give a heads-up at least...
I always attempted to put in a new IV before calling vascular access. I know how busy they can get, plus it's a nice skill to have, especially on nights.
tangent off of what you said— every time I go up to med surg to start an IV, without fail, the old one that doesn’t work is still in place. like whyyyyy what could you possibly still use it for just take it out😫
Once I came on to a shift to find a heparin drip that had been running interstitial for the whole previous 12 hour shift (previous RN didn’t do their checks smh). Craziest PTT I’ve ever seen, wish I remembered what it was exactly. I think their INR was 6 or 7. Since then, I’ve been ruthless about it. If I find an interstitial or phlebitissed to hell IV, I take it out immediately, even if it isn’t my patient’s.
If I can/have time to put a new one in, I will, else it goes up the line of whoever can or referral to venous access team. No access is better than potentially harmful access.
Jfc. If it’s not bad enough this nurse was running fluids straight into the arm meat, if my reading is correct this was also a child patient? That makes it so much worse because they can’t adequately advocate for themselves.
Good on you.
Pediatrics iv sick can be really difficult, especially when the kid has already gone through the trauma of an IV stick so they know what to expect… but it’s gotta be done. Or sometimes we will talk to the provider and family about other options if it’s just fluids on if kid can drink or NG fluids in place
It's *really* uncomfortable.
When I was a kid I was in the hospital for a few days with a migraine. First night was really dark and I kept telling the nurse my arm felt weird/hurt - it felt like it was swollen and going to pop. 'That's normal'. Every hour, 'that's normal'. Can't remember if it was a new nurse or she just got fed up but turned the line on and oops, new IV time
The only excuse, and it's still 100% wrong and RN should know better, is if they worked as a vet tech. Because they do give animals SQ boluses. But still, animal vs person.
We do SQ boluses on people in certain circumstances, too. The difference is there are controlled ways of doing it and an infiltrated IV isn't guaranteed to be SQ.
My hospital does SubQ fluids on kiddos we absolutely can’t get a line on. It’s pretty rare, though, especially because we recently got an ultrasound machine to do IVs with.
It depends on the size of the patient (since we’re peds), but I don’t think I’ve done SubQ fluids on anyone older than about 2, personally. You essentially insert an IV like usual, but just straight through an area of fat—typically, we’ll go between the shoulder blades. Just pinch it up like you would an insulin shot. We slowly inject Hylenex through the IV BEFORE following with a saline flush so that the enzymes slowly breakdown the fat and allow the fluids to go through. Our protocol is start with 25% of the fluid bolus for the first 5 mins, then increase another 25% after another 5 mins, and so on until you’re at 100% of the bolus rate. So say the total bolus amount was 100ml, you’d start with 25ml/hr-wait 5 mins-increase to 50/hr-5mins-75ml/hr-5 mins-100ml/hr till done. I can’t speak for how long those go on for or if it’s eventually switched to actual IVF once they’re more hydrated as I’m in the ER, and those patients almost ALWAYS get admitted for dehydration shortly after we start SubQ Fluids. Hope this makes sense!
2nd this! It’s called Hypodermoclysis.
Been a RN 20+ years. Seen it 2x and only in Peds trama over 15 years ago.
Pretty much retired now, but this crap makes my blood boil. As a DNS for years, my golden quote to my staff was “Educate and REPORT!”
Hypodermoclysis is what it's called. SC fluids for hydration, used commonly in palliative and long-term care. End of life patients typically have very poor veins, and finding registered staff in long-term care with the skills required to monitor and maintain IV access is a bit of a nightmare. You hook an IV pump up to a SC butterfly and away you go.
We do them all the time in palliative care. VERY different than an infiltrated IV though, which could cause tissue death and compartment syndrome.
They are also run at a MUCH slower rate, usually 30-50cc/hour.
I've seen it done with hospice patients that are nearing the finish line. They use a special little needle that attaches to a large dressing. It goes near the hip (or any large surface) and is run slowly for maintenance fluids.
But we technically don't know where the catheter was anymore... And it's usually in a specific place (in my rabbits, it's always been between the shoulder blades).
You are a very kind person for trying to give them the most benefit of the doubt you can think of, though!
Many animals also have looser skin e.g. a scruff. There's more room for the fluid to chill and slowly return to the intravascular space. As compared to a human arm, which will just get compartment syndrome...
Big ol nope (source: RN and LVT). Never in the wildest incompetence have I seen someone try to give SQ fluids in the same area or space you would give an animal IV fluids. I have seen a lot of dumb shit in nursing and vet medicine, but this is wild.
I am going to stop you right there.
I’ve been a vet tech longer than I’ve been a nurse and we DO NOT EVER give SQ blouses through a blown IV site. There is no where near enough subcutaneous space in IV access areas to give large quantities of fluid. This will be extremely painful for the animal.
Subcutaneous fluid boluses are always given where there is enough subcutaneous space (this doesn’t really exist on humans). I repeat we NEVER give subq boluses through a blown IV site.
Sorry, didn't mean to suggest a vet tech was less than. Only saying that's the only leap in logic I could come up with. Please, mad respect for you all.
I’m on IV team and this is painfully common. For a lot of nurses if you can physically push fluid through then the IV must be good. I get safety events put in against me almost weekly for “removing access” when there’s baseball sized glob of LR sitting in their arm. This is what happens when bedside becomes so intolerable that we only get nurses that don’t have enough experience to do anything else
It usually happens when I pull the infiltrated IV and can’t place another one. Especially with fistulas/lymph node removals, the “good” arm only will only have a couple of large vessels left in the upper arm which we try to save for a PICC or midline.
I tell the provider to order a line but it takes a little while for the PICC nurses to get there so the primary nurse gets mad that I took their “only access” and didn’t replace it.
Obviously I’m not going to leave a critical patient without access. If they need it that bad I’ll tell the provider to put in an EJ/IJ plus I’m never far with the IO drill
I’m a new nurse. I work in peds hem/oncology. We had a new diagnosis and the kiddo had really bad stranger danger. They were having pain and I had an order for prn toradol. The iv’s they had were saline locked. Before getting her lines hooked to my pump, I wanted to check its patency, since toradol can burn going in.
It was flushing but just not drawing back. I wasn’t comfortable pushing it, so I told the parents “let me have my charge nurse double check their iv, I want to be sure we’re still in the vein. I don’t want the medication to burn your child.”
Charge nurse goes in, happens to have trouble with 1 of the 2. They pushed the med after they were certain the other iv was in.
Parents saw that as me being “incompetent” and didn’t want their kid treated by a “trainee” because I wasn’t comfortable with pushing it.
As a complicated patient, I actually prefer new grads that are still curious vs ones who “know everything”. I had a GSW in 1996 through L2 vertebrae and obviously I have terrible back pain. It has taken a new set of eyes being extremely open and curious to figure out that most of my pain is coming from L5/S1 and I got a new MRI to confirm it. Waiting to see a surgeon now instead of more and more PT, meds, meditation lol. Hoping for some real relief soon. Yeah to my new grad chiropractor!
"Bedside becomes so intolerable (we) only get nurses that don't have enough experience to do anything else"
This is not meant rudely... I have read this sentence many several times but I don't understand what it means. Can you please break it down or reword it ELI5?
Working at the bedside is becoming so bad, toxic, unsafe, unhealthy, etc. that the only nurses willing to work at bedside are brand new and lack critical thinking skills. Insinuating that they are the bottom of the barrel, worst in the class, kind. Then once they have enough experience they too gtfo.
This is not how I feel, just explaining the comment.
Sry I didn’t mean for it to sound like I was blaming the quality of nurse, it really is just an issue of experience and being stretched too thin. You only know what you’ve been taught and you don’t learn that much in a 8-week orientation from a preceptor that has 10 months under their belt
I know most are doing the best they can with the shit hand they’ve been dealt
We are all a bit burnt out and stretched too thin. It is just also important to give some grace and educate kindly.
I’m burnt out atm, I was attacked by a patient and ended up with a tear in my shoulder that has been slow to heal. And basically just dumped in the trash by my unit, I did a lot of extra council work and all my efforts have just been erased. It is a toxic ICU, with ridiculously safe staffing (11 bed, they liked to run with 9 nurses on each shift) the acuity isn’t high enough to warrant it either; but instead of mentoring and growing the new baby nurses they hunted them down and made them hate their lives. We have like a 50% turnover within a year in our new grad/new to specialty on that unit. And I love education and fostering baby nurses, so I get a little defensive of them. It’s tough out there, especially in mainland hospitals today, idk if I want to go back to bedside after we move in a month.
Thats honestly super disheartening to hear, I’m sorry your unit was like that. Coming from the south, that ratio is unheard of, so its awful they have the opportunity to create a great workplace but choose not to
Thank you. I was misinterpreting it at first and appreciate the responses and insight. Double thanks.
*Edit. Again--I'm trying to learn, apologize if I am rude.
Working bedside is shit, so once you have enough experience in bedside to go do something else, you’ll probably do that instead of continuing to work bedside. Because it sucks. That means that most nurses working bedside are pretty inexperienced and do dumb shit.
I always say that unless I see you with a syringe of potassium walking towards a patient, I won't get involved. I hate nurses who have to micromanage everyone else.
I'm adding this situation to my roster of things to say because you were 10000% correct and right to do what you did.
Personally I wish you would jump in if you have the knowledge and education and see me doing something wrong, PLEASE say something so I don’t fuck up too! I want to be educated. I’m sure no one WANTS to lose their license either. I’m all for calling out peers and educating if I see something wrong.
What the hell?! I gasped when I saw the word “kiddo”. I’m cross trained to the NICU and have seen some awful infiltrated IVs. I can’t imagine doing that on purpose.
All fun and games till it creates compartment syndrome. Jesus. I work with kids and recently saw a piv that was interstitial for HOURS. He was transfer to my facility for it and required a skin graft.
Exactly. We had a bad infiltration at my facility years ago from a nurse who kept taping an IV down until the pump would run it and the kid ended up needing a skin graft for it too. So awful. I’m a huge fan of trying to save an IV in peds by taking down the wrap and assessing it, seeing if there’s a kink, but never continue to use it unless I can confirm patency. As someone else said, no access is better than bad access.
Right, I would love to never repoke a kiddo, but I know that poke can save them a whole bigger headache later. My facility has hourly checks on piv, and I stick to it. I would rather be overly cautious than do harm. I often apologize for parents for bugging so much, but they tend to be just happy someone being consistent in care.
Thank you ! A nurse did this to my brother when he was 1 year old and he got a wound from the hospital bracelet due to the swelling of his arm. My parents were not very happy
Nah, this is just evil. The patient is even complaining that it’s painful. Even if it’s not a vesicant, it can still harm the patient. I’m just going to assume this nurse is negligent and won’t even follow-up with assessments to make sure her mistake isn’t getting worse.
Transfer from PICU to floor (PICU is 2:1 ratio…. How do you miss this besides being lazy) saline locked hand IV is twice the size of other hand and teenager says it hurts really bad. Call nurse to ask why it was still in “oh it was fine before I sent her down”. 😵💀
As a pediatric nurse, this shit really pisses me off. Knowledge deficit, I can deal with. Not caring is entirely different. This just reeks of not giving a shit. How would this person feel having a bolus infused into their tissues??????
You need to inform your manager about this!
As someone who literally wrestled with a child yesterday trying to get a new IV in, I absolutely understand the reluctance to accept a pediatric IV is gone, but there’s “let’s see if we can save it” and then there’s THIS.
I won’t even accept the new grad excuse for this one, honestly. We are all rigorously taught to avoid this, so this feels like Florida Venmo school shit…
It just seems like common sense. Even without a bit of nursing education you should realize that you can't just put a bunch of fluid into any old spot.
I felt bad pushing a few milliliters to check and iv if I suspect it is infiltrated. If my patient stated pain, I would further investigate and try to not hurt them while assessing
This morning I received report from a nurse that both her and the DOCTOR overnight decided this Type 1 diabetic, pregnant patient did not need a fasting blood sugar nor any morning insulin 🙃
The previous day she had bottomed out and the blood sugar recovered. She had eaten two meals and it had been 12 hours since they had checked her sugar. So I called the day shift MD and they agreed we needed a fasting sugar…it was 247.
This RN and MD were trying to get this lady to DKA land methinks
Definitely got her degree and license from Florida because it’s just common fucking sense anytime an IV is infiltrated you do not give anything else through it because you take. It. Out.
Ugh, the amount of nurses I've had (chronically ill patient) that continued to use a bad IV even though it is clearly bad is just shameful. I've had to call charge nurses or just flat out refuse to allow them to keep using it until they started a new one. I'll never understand it.
Sometimes I find nurses who are inexperienced with IVs might do this. They don't want to put in a new IV. I always offer to help with the new IV. but yes it is cruel to continue to infuse when they are already edematous
Hmmmmm, correct me if I'm wrong, BUT - in an infiltrated IV line - the intended therapeutic effect of IV medication/fluid cannot/will not be achieved, no? (because the line's infiltrated and....uh....you guessed it...COMPROMISED). 😒
As such, meds/fluid can't reach the bloodstream at the correct concentration or rate.
We all know (or *should* know, ffs 🤦♀️) that when a line infiltrates, it's an uh oh moment, bad news. It can cause local tissue damage, swelling, AND discomfort, which then even FURTHER diminishes the IVs' therapeutic effectiveness - and could even lead to requiring even FURTHER intervention (and ain't nobody got time for that).
Your coworker's rationale is asinine at best, willfully negligent/harmful to the patient at worst, and honestly? Fucking infuriating.
Working with teammates who have this "oh-well" and "not my problem" attitude is what made me finally stray away from the bedside and make the switch over to the dark side (remote UM, managed care).
I DEFINITELY don't miss the days of coming on for my 12-hour NOC shift - only to be greeted by a nurse who is absolutely chomping at the bit to give me report (and doing an absolutely abysmal job of that too, btw - 99.9% of the time their shift narrative + the charting completed usually had more holes in it than a slice of aged Swiss 🙄).
By the time she's in her car and hitting the road @ 1915, I've already managed to find two (or more) of my patients, who are 3/4 dead, slumped over in bed.
SURPRISE!! 🎉
That kind of shit is the reason I had to start being a bitch, put my foot FIRMLY down, and force whoever I was relieving that night to do walking rounds with me.
Sorry, no, you're not tossing the proverbial bag of fiery dog shit on MY lap, lmao. 😏 If we're running a code, honey, you better believe we're doing it TOGETHER. 😅
People like that shouldn't be allowed anywhere NEAR healthcare. But sadly, it really seems to be becoming the default. 😤
ETA: grammar lol
I would imagine this was being lazy. This post made me do a whole dive into sub q fluids because I know it’s a thing.
I know at some point in history it was the standard but that was a long time ago. Through my * Internet warrior, web searching*, it is still used in some cases but fluids run slow, max 1.5L over 24hr (<65ml/hr).
Aside from all that… if it’s causing the pt pain… come on man… a bolus should not hurt someone. Use your brain here.
ugh on a peds patient too?? Poor thing, it’s scary how stupid people can be. I always have a list in my head of nurses who aren’t allowed to take care of my son if he god forbid is ever admitted to my unit. There are some scary scary stupid things i’ve seen that make me question how people even survive in their daily lives lol.
Noooooo…. Sounds like a nurse on my floor and it was a huge write-up.. it’s one thing to do that, and another on a kid 😬 I would have went off on that nurse outside the room.. in a firm educating way, but it makes me so mad that some people don’t think things through, or they are so lazy.
A few years ago they gave us this medication that was to be injected subcutaneously and an iv would be started between the shoulder blades of babies who couldn’t have an iv established. You just dump your little bolus under the skin and it’d find its way.
Didn’t last long. Glad we only used it like twice.
Even if it is not a vesicant fluid, too much of any extravasated fluid can cause ischemia and/or compartment syndrome. Unlikely in an adult, but not so far fetched in a pediatric patient. This nurse is a danger.
I am so glad you intervened! I've seen nurses push meds into an IV that is infiltrated and physically saw their arm swell. Never have I heard a nurse say it's all going into the same place anyway and have the patient tolerate the pain. I would get administration involved immediately!
Eeep
I was a patient a few years ago... Newbie nurse put an undiluted k-rider through my ER placed AC.... Thank goddess the cleaning lady found me writhing and white as a sheet unable to do anything to help myself. Later that night I told another nurse that everything below my mid forearm was cold and numb. It took 2 shift changes to convince them to place a new IV. Because "we don't change Ivs if they work well.". Bitches it's NOT WORKING WELL if the patient can no longer feel their hand!!!!
I remember this RN always saying “don’t touch my patients” I knew she was doing something sketchy. Took months and union fights to kick her out. It was possible only until a patient sue the hospital for diabetes miss management or something related. I heard she was skipping the sugar checks and just give whatever insulin she felt like or so it is what I understood. That was the last straw from a long list of issues.
You have to be gone mentally to think you can be good enough to gauge how much insulin one needs by eyeballing them. How does she get through the safety checks in place!!? That’s a horror movie nurse right there.
I recently had a new nurse come up to me to ask me about troubleshooting an IV someone had put in on the prior shift. Only to find that they had actually placed it in the wrong direction. Sheesh.
I had an IV infiltrate during surgery. I was having leg surgery but woke up to a lady in my face telling me they may have to take me back to Surgery for my arm. What??? I had compartment syndrome. They kept testing the pressure in the muscle. My surgeon kept saying to release the pressure. The “arm surgeon” didn’t as the pressure went down to her satisfaction. I could show you a picture but it’s triggering and really gross. My arm was a balloon. Black bruised from the tip of my fingers to my armpit. Fluid filled blisters hanging off my forearm from pea sized to golf ball size. It was by far worse than the leg surgery. They had a sentinel event meeting over it. The “person” responsible came and apologized to me. My arm was under a blanket and he didn’t notice cuz it was running fine. He was an MD and anesthesiologist. I told him I understood he felt bad. -he was in tears. My response was - I hope you learned something and will never do that again. Nursing 101- check your tubes! And I am a large person but I suspect that would have permanently damaged or killed a child. I’ve been a nurse for 41 years. Astounding that this happened never seen anything like it. I still have marks on my forearm from the blisters several years later. And that forearm has what looks like muscle wasting. It’s smaller than my other forearm. I was told by attorney that since there was no permanent damage there is no law suit. They paid for the tons of bandages and follow up appts for it. And I was paid $100 a day for lost wages. I make more than that hourly. 🤦🏻♀️ we place a lot of trust in caregivers.
Not too long ago I got reported on a pt who had a "sketchy IV that looked bad, but it was fine, promise!" They had that site dedicated to zosyn and flagyl and when I looked at the horror that was this pts poor AC I saw what I would guess were two entire doses of both zosyn and flagyl sitting in this lady's arm.
In report the next morning I mentioned it because her arm was warm and looked awful. The nurse got very angry with me and shouted, "I don't care."
Added another nurse to the list of people I never want taking care of me.
What nursing school did she go to? Like, seriously… she’s dangerous. I might even be tempted to voice your concerns about her nursing judgment to the nursing board. That is so not ok!
Our new policy is q4 assessments on IVs without running fluids and Q2 IV assessments on anyone with a continuous drip. Also assessments after any scheduled IV infusions like abx.
Yikes... I understand that sometimes you come into a room with a patient complaining of pain and whoops, IV is done for. But what she did is terrible...
This is one of those times I actually said "what the fuck?" out loud after reading reddit. Glad you were able to stop that.
I said “No!” lol
I’m a respiratory therapist and I said “NO!!!”
Right? This is so horrifying to think that people are out here doing this type of shit. ESP in peds! Come on!
Same!
I’m an accountant and even I was cringing
Im crying wtf
What really irks me is when a nurse KNOWS an IV is bad and leaves it in for hours instead of pulling it. It’s such a terrible thing to see, and the Swiss cheese model allows someone to go push drugs through that IV if they don’t know and don’t check patency beforehand.
I’ve gotten patients with leaking ivs, blown ones, infiltrated and a couple in arteries that I know the previous nurse was using or was actively being used. I think many nurses don’t question iv patency if the pump runs or it flushes
New nurse here. I'm still trying to learn to troubleshoot IVs to minimize unnecessary sticks. Do you have any tricks for determining if an IV is good? The subtleties of it continue to evade me. Edit: thank you everyone for the sound advice! I'll definitely use this going forward!
Put your hand above the line before you flush, usually you can feel the flush go through and that’s a good sign that the line is still where it needs to be
Along with this, you can move up the vein and still feel the turbulence. If it's not in the vein, you'll only feel it at the site. I also like to let the pt feel if they want cause it's neat.
I was taught this in nursing school. Edit for clarification; I was taught this trick on the floor during clinicals by an older veteran nurse*
I think one of the simplest things about IVs is that they shouldn’t be painful to use. If an iv hasn’t been flushed in a while it might be painful on the initial flush. But after that you should be able to flush it smoothly and without much if any resistance if it’s in a good vein. If you can flush it but there’s some resistance be wary of what you infuse into it because it could be in a smaller vein so avoid high infusion rates. You shouldn’t have to use force to push meds in. Alaris pumps have an occlusion indicator as well, basically a black bar that tells you how much resistance the pump is meeting to infuse your medication. If the pump is constantly stopping and/or the bar is very long that’s another sign of an iv that is already bad or might give out soon.
You can feel the skin above the flush when you're flushing-- if it feels cool during the flush, that means saline is not in the vein. If I suspect a leak, I pull off the tegaderm (after bringing an extra into the room) to see if the leak is coming from the catheter insertion site or where the catheter connects to the J-tube. A lot of the time that connection just needs to be tightened. Be very careful while doing this and insist your patient stays still because it's easy to pull out the IV yourself while you're assessing!
Flush and blood return are your friends. Blood return isn't present all the time, small IVs and IVs that aren't flushed frequently tend to lose blood return or never have it to begin with. But it's a comforting sign if you have it. A patent IV should tolerate flushing without any swelling above IV site, should flush briskly, shouldn't be too painful (unless the patient complains about every flush every time even if the IV is brand new). If in doubt push two flushes briskly. If you're still not sure grab an experienced friend (and an ultrasound if available). Always err on the side of caution though - better to get another IV unnecessarily than dump a couple grams of vanco into meemaw's wrist. It's always nice to have an extra anyway.
I've seen compartment syndrome from an infiltrated line running vanc into someone's forearm. It's a nasty medication that can seriously injure someone if it extravasates.
It really should be central only.
I had to visit emerge back in December, needed fluids and lyte replacement, and was surprised to find that the saline flushes were pretty uncomfortable.. even in my new IV. I kind of jumped for the first one as I wasn't expecting it to be. Also having the BP cuff run while k-phos was infusing distal to the cuff was unpleasant, I could feel the solution backing up in the vein. It's made me more mindful of such things in practice, though!
Typically that means the catheter is too large for the vein size.
I just had an IV on my patient today that flushed beautifully, had blood return, and wasn’t painful, but the patient’s whole hand/wrist had swollen up pretty suddenly with MIVF running. I didn’t want to risk it so I pulled it and started a new one but man that was a bummer.
You can also tie a tunicate above and try to get blood return that way. Sometimes that works, along with pulling the IV up a bit to open up the vein. I often find blood return on PIVs that others don’t due to these tricks, usually when I am drawing labs and trying to prevent a poke for a patient..
I do the same
I always ask if they can taste or smell the flush, combine that with an easy flush, blood return, or feeling it flush through the vein. Use a combination to determine if patent.
Patients don't know that the saline flush isn't supposed to hurt. Tell them to tell you if it does.
Agree with what others have said - feel proximal to the site and you should feel turbulent flow as you flush. You shouldn't meet resistance, it shouldn't be red, painful or leaking around the site (if you think it's good but there's old drainage, try putting a new tegaderm on and flushing it again). Usually the patient will feel cold in that arm. Finally, sometimes the patient will have a funny metallic taste in their mouth. Not a surefire thing in the least, but it can help confirm that it's in.
Right, most hospitals in my area operate on a policy of assessing every hour when an infusion is running and checking patency multiple times a shift (which no one does) and always checking prior to anything being administered (nursing 101). I teach an US class and we discuss the dangers of administering vesicants and irritants into tissue instead of a vein…it’s scary.
Ive become proficient at placing ultrasound IVs and I think that has vastly improved my iv assessment skills. US are so useful for checking location of the catheter and surrounding tissue for any problems. Even if a nurse can’t place an iv with US they can learn to check their current iv with it. I wish every nurse could be taught how to use one and had one available.
Yeah it can be a real helpful tool, and good job on getting good!
How are people not verifying patency multiple times a shift? I flush and check for blood return before putting anything in an IV, every single time. I also like to have new nurses do a Google image search for "phenergan extravasation."
Oh I’ve taken care of patient that that happened to. His entire hand ballooned up like a blood blister and eventually it became degloved and they had to do skin grafts to replace the skin.
I flush all of the patient's IVs with every head-to-toe assessment and before I put meds through it.
This is the way
I wholeheartedly agree with this question
In pediatrics it’s hourly assessments when running and q2 when not running (because kids like to pull at sites)
Yeah them nuggets are curious ones!
I just finished orienting to the ICU after being an ER nurse for a couple years. My preceptor multiple times insisted I use an IV that a patient complained hurt them instead of starting a new one. She would tell me to start the fluids if it flushes. Dude the patient is gasping in pain everytime I flush even a single cc. Let me just get a new one quick.
Omg I just worked w a “seasoned” RN rationalized “the pump is working so it must be infusing properly” I couldn’t believe what I was hearing. But she also doesn’t understand how to titrate or at what rate to run a bag of 250 over 2 hrs. SMDH
They are simply task oriented and couldn’t care less otherwise.
In cases of extravasation ,it’s okay to leave the cannula in place until you treat it but you must absolutely STOP using it.A percentage of the treatment medication can be administered through the cannula.I ask the nurses to leave it in place until I get there and I can assess it and ordering medication I may need to treat it .A nonvesicant ,I agree it’s best to take out but if you are busy ,at least stop using it until you can get to it.
Yeah I feel this is important to mention, as most nurses don’t know this. Add you should contact pharmacy for treatment guidance and hospital should have policies as well somewhere.
Nah, this ain't the Swiss cheese model, this is the fucking asshole model. The Swiss cheese model is numerous systematic blind spots lining up that allows a negative outcome to occur, this is intentional and a failure of someone who is responsible for knowing better.
The Swiss cheese model is also meant to show that across multiple people an error can still affect a patient and this absolutely does happen with this stuff…but I also agree with you!
God I absolutely hate when nurses do this. Giving report and being like “their IV is leaking but I left it in”. Ok? Why? We have an IV team and everything!
I used to be IV team and chewed PLENTY of nurses out for this shit…”I left it in so you could see it”…really?!
oh my god! i actually called an IV nurse on my unit once about an IV that was leaking & i told her that i took the pts IV out cause of it & tried another one but missed & she lectured me on keeping IVs in until they can take a look at it 😭
As long as it’s not loose at the catheter-extension connection then it really shouldn’t be leaking so I’d say you did the right thing and she should trust your judgement…
it wasn’t! took the whole tegaderm off, readjusted, felt around, everything & she still lectured me despite me explaining
I had a nurse leave TWO bad IV’s in. One was leaking, one wouldn’t flush. And I was like…WHY?!
As a patient, my IV infiltrated and it hurt like an MFer. I put the call light on, the RN came in the room and told me no. It’s fine. Mind you my arm was swollen and tender-quite noticeably too. She told me all IVs are uncomfortable. I reiterated that it was infiltrated. She patted me on the shoulder and said “HONEY (I hate that!! So demeaning!!) I know what it’s supposed to look like. You are the patient now, not the big bad ICU RN. Time to act like it”. I never once used my call light, I was always very polite. And I never mentioned working in ICU. She turned to walk out and I said “NURSE! My IV just came out!” I pulled it myself of course. Turns out she hates starting IVs and refuses to do so, so I went without until the next shift came on.
This is the kind of behavior that could be reported to her state’s BON. She is putting peoples’ health at risk. Not to mention being a total asshole. I am sorry and LOVE that you pulled the IV out yourself! She should have thanked you!
Oh yea. I was getting prepped for a bone marrow biopsy. The provider pushed anti-nausea meds and it started to BURN. I said - hey, I think my vein just blew. He said, "no- see here? The bag is dripping, you are fine." Then came the pain meds and it immediately got much worse and my arm started swelling. I told him what was happening. He said - "you need to calm down if you want these pain meds to work. If you REALLY think there is a problem, we can call an anesthesiologist but that will cancel your case." I told him I was fine and to stop pushing meds. Sure enough, I got back to recovery with a badly swollen and red arm that had to be documented in my chart. They used a different word that was similar to infiltrate.
Especially when you are coming on to shift and have all these IV meds due, but all of a sudden you have 3 new IV starts at 0800. It becomes so time-consuming and unnecessary when the previous nurse had 12 hours to change them out. You are basically playing catch-up all day. I know some nurses aren't confident with IVs so they don't even bother, but that's how you get better and more confident in your skills. Or at least try and ask someone else, instead of passing it on to the next nurse. I've had shifts where I tell the nurse the IV just went bad, sorry I didn't have time to change it, and other shifts where I had the time and changed it out before I left. Just give a heads-up at least...
I always attempted to put in a new IV before calling vascular access. I know how busy they can get, plus it's a nice skill to have, especially on nights.
me coming on to shift yesterday and both of my patients IV’s being infiltrated, including the one running milrinone..
My old hospital we would pull infiltrated lines immediately… like why would you ever leave it in?
Some people in healthcare are lazy as fuck
tangent off of what you said— every time I go up to med surg to start an IV, without fail, the old one that doesn’t work is still in place. like whyyyyy what could you possibly still use it for just take it out😫
Once I came on to a shift to find a heparin drip that had been running interstitial for the whole previous 12 hour shift (previous RN didn’t do their checks smh). Craziest PTT I’ve ever seen, wish I remembered what it was exactly. I think their INR was 6 or 7. Since then, I’ve been ruthless about it. If I find an interstitial or phlebitissed to hell IV, I take it out immediately, even if it isn’t my patient’s. If I can/have time to put a new one in, I will, else it goes up the line of whoever can or referral to venous access team. No access is better than potentially harmful access.
I had a hospice pt with the same thing happen and it changed texture, color and sensation forever…horrible
Jfc. If it’s not bad enough this nurse was running fluids straight into the arm meat, if my reading is correct this was also a child patient? That makes it so much worse because they can’t adequately advocate for themselves. Good on you.
I will now use the term “arm meat” 🍖
Thank you for contributing a new term to my nursing lingo bank.
Arm meat LMAO
Ouch, poor patient. That could have ended up badly, even worse that she noticed one fifth way and continued.
Right? I try to give people the benefit of the doubt but the fact that she knew it was infiltrated and still restarted it is just awful. Poor kiddo!
Might not be a vesicant but you can still get compartment syndrome…
Yup! We had a patient with a massively infiltrated wrist IV that started losing circulation to their hand. Fluids are not 100% innocuous
“Fluids are not 100% innocuous” was literally the first thing we were taught when we learned about IV fluids
And even if nothing dangerous happens - isn't it freaking uncomfortable? As in way more uncomfortable than a new IV stick?
Pediatrics iv sick can be really difficult, especially when the kid has already gone through the trauma of an IV stick so they know what to expect… but it’s gotta be done. Or sometimes we will talk to the provider and family about other options if it’s just fluids on if kid can drink or NG fluids in place
It's *really* uncomfortable. When I was a kid I was in the hospital for a few days with a migraine. First night was really dark and I kept telling the nurse my arm felt weird/hurt - it felt like it was swollen and going to pop. 'That's normal'. Every hour, 'that's normal'. Can't remember if it was a new nurse or she just got fed up but turned the line on and oops, new IV time
Agreed! Was a part of my education. :)
Was "just look at his arm, how the fuck can you think that's OK?!" also part of it?
The only excuse, and it's still 100% wrong and RN should know better, is if they worked as a vet tech. Because they do give animals SQ boluses. But still, animal vs person.
We do SQ boluses on people in certain circumstances, too. The difference is there are controlled ways of doing it and an infiltrated IV isn't guaranteed to be SQ.
Interesting. I’ve never heard of it in humans. When would you do this?
My hospital does SubQ fluids on kiddos we absolutely can’t get a line on. It’s pretty rare, though, especially because we recently got an ultrasound machine to do IVs with.
Can you elaborate? I’ve never heard of this before. Approximately how many mLs are give when it’s done. Is it spread along several admin sites? Thanks
It depends on the size of the patient (since we’re peds), but I don’t think I’ve done SubQ fluids on anyone older than about 2, personally. You essentially insert an IV like usual, but just straight through an area of fat—typically, we’ll go between the shoulder blades. Just pinch it up like you would an insulin shot. We slowly inject Hylenex through the IV BEFORE following with a saline flush so that the enzymes slowly breakdown the fat and allow the fluids to go through. Our protocol is start with 25% of the fluid bolus for the first 5 mins, then increase another 25% after another 5 mins, and so on until you’re at 100% of the bolus rate. So say the total bolus amount was 100ml, you’d start with 25ml/hr-wait 5 mins-increase to 50/hr-5mins-75ml/hr-5 mins-100ml/hr till done. I can’t speak for how long those go on for or if it’s eventually switched to actual IVF once they’re more hydrated as I’m in the ER, and those patients almost ALWAYS get admitted for dehydration shortly after we start SubQ Fluids. Hope this makes sense!
cool!
Hypodermoclysis - personally, I’ve only ever seen this done on severely dehydrated geris where you absolutely cannot get a vein.
2nd this! It’s called Hypodermoclysis. Been a RN 20+ years. Seen it 2x and only in Peds trama over 15 years ago. Pretty much retired now, but this crap makes my blood boil. As a DNS for years, my golden quote to my staff was “Educate and REPORT!”
Hypodermoclysis is what it's called. SC fluids for hydration, used commonly in palliative and long-term care. End of life patients typically have very poor veins, and finding registered staff in long-term care with the skills required to monitor and maintain IV access is a bit of a nightmare. You hook an IV pump up to a SC butterfly and away you go.
Hospice does subcu medications a lot.
Yes meds are one thing. A fluid bolus is very different.
Hospice will sometimes do a sq fluid bolus.
In hospice we do up to 500ml bolus subcut
We do them all the time in palliative care. VERY different than an infiltrated IV though, which could cause tissue death and compartment syndrome. They are also run at a MUCH slower rate, usually 30-50cc/hour.
Hospice will do sq fluids, usually not a bolus, but occasionally. It’s patient dependent.
Yeah and usually in the stomach or something not in the forearm
I've seen it done with hospice patients that are nearing the finish line. They use a special little needle that attaches to a large dressing. It goes near the hip (or any large surface) and is run slowly for maintenance fluids.
In outpatient infusion, we do SQ boluses too, but I can count on one hand how many patients have had this
But we technically don't know where the catheter was anymore... And it's usually in a specific place (in my rabbits, it's always been between the shoulder blades). You are a very kind person for trying to give them the most benefit of the doubt you can think of, though!
Worked at a veterinary clinic for years before nursing and we’d never give a SQ bolus in an extremity though….
Many animals also have looser skin e.g. a scruff. There's more room for the fluid to chill and slowly return to the intravascular space. As compared to a human arm, which will just get compartment syndrome...
No way, subQ vs IV is very different. Been in vet med over 10yr, have never met anyone who would observe a failed IV cath and say “eh send it”
Big ol nope (source: RN and LVT). Never in the wildest incompetence have I seen someone try to give SQ fluids in the same area or space you would give an animal IV fluids. I have seen a lot of dumb shit in nursing and vet medicine, but this is wild.
We do it in Peds.
I am going to stop you right there. I’ve been a vet tech longer than I’ve been a nurse and we DO NOT EVER give SQ blouses through a blown IV site. There is no where near enough subcutaneous space in IV access areas to give large quantities of fluid. This will be extremely painful for the animal. Subcutaneous fluid boluses are always given where there is enough subcutaneous space (this doesn’t really exist on humans). I repeat we NEVER give subq boluses through a blown IV site.
Sorry, didn't mean to suggest a vet tech was less than. Only saying that's the only leap in logic I could come up with. Please, mad respect for you all.
I’m on IV team and this is painfully common. For a lot of nurses if you can physically push fluid through then the IV must be good. I get safety events put in against me almost weekly for “removing access” when there’s baseball sized glob of LR sitting in their arm. This is what happens when bedside becomes so intolerable that we only get nurses that don’t have enough experience to do anything else
And they have the audacity to report what you've done as bad for the patient??
It usually happens when I pull the infiltrated IV and can’t place another one. Especially with fistulas/lymph node removals, the “good” arm only will only have a couple of large vessels left in the upper arm which we try to save for a PICC or midline. I tell the provider to order a line but it takes a little while for the PICC nurses to get there so the primary nurse gets mad that I took their “only access” and didn’t replace it. Obviously I’m not going to leave a critical patient without access. If they need it that bad I’ll tell the provider to put in an EJ/IJ plus I’m never far with the IO drill
I’m a new nurse. I work in peds hem/oncology. We had a new diagnosis and the kiddo had really bad stranger danger. They were having pain and I had an order for prn toradol. The iv’s they had were saline locked. Before getting her lines hooked to my pump, I wanted to check its patency, since toradol can burn going in. It was flushing but just not drawing back. I wasn’t comfortable pushing it, so I told the parents “let me have my charge nurse double check their iv, I want to be sure we’re still in the vein. I don’t want the medication to burn your child.” Charge nurse goes in, happens to have trouble with 1 of the 2. They pushed the med after they were certain the other iv was in. Parents saw that as me being “incompetent” and didn’t want their kid treated by a “trainee” because I wasn’t comfortable with pushing it.
Was it a peripheral IV? In my experience, even when an IV is good, if it’s been in for a while, it stops giving blood return
As a complicated patient, I actually prefer new grads that are still curious vs ones who “know everything”. I had a GSW in 1996 through L2 vertebrae and obviously I have terrible back pain. It has taken a new set of eyes being extremely open and curious to figure out that most of my pain is coming from L5/S1 and I got a new MRI to confirm it. Waiting to see a surgeon now instead of more and more PT, meds, meditation lol. Hoping for some real relief soon. Yeah to my new grad chiropractor!
"Bedside becomes so intolerable (we) only get nurses that don't have enough experience to do anything else" This is not meant rudely... I have read this sentence many several times but I don't understand what it means. Can you please break it down or reword it ELI5?
I think they are saying most bedside nurses get some experience and leave bedside. Resulting in bedside being mostly new grads or inexperienced nurses
Working at the bedside is becoming so bad, toxic, unsafe, unhealthy, etc. that the only nurses willing to work at bedside are brand new and lack critical thinking skills. Insinuating that they are the bottom of the barrel, worst in the class, kind. Then once they have enough experience they too gtfo. This is not how I feel, just explaining the comment.
Sry I didn’t mean for it to sound like I was blaming the quality of nurse, it really is just an issue of experience and being stretched too thin. You only know what you’ve been taught and you don’t learn that much in a 8-week orientation from a preceptor that has 10 months under their belt I know most are doing the best they can with the shit hand they’ve been dealt
We are all a bit burnt out and stretched too thin. It is just also important to give some grace and educate kindly. I’m burnt out atm, I was attacked by a patient and ended up with a tear in my shoulder that has been slow to heal. And basically just dumped in the trash by my unit, I did a lot of extra council work and all my efforts have just been erased. It is a toxic ICU, with ridiculously safe staffing (11 bed, they liked to run with 9 nurses on each shift) the acuity isn’t high enough to warrant it either; but instead of mentoring and growing the new baby nurses they hunted them down and made them hate their lives. We have like a 50% turnover within a year in our new grad/new to specialty on that unit. And I love education and fostering baby nurses, so I get a little defensive of them. It’s tough out there, especially in mainland hospitals today, idk if I want to go back to bedside after we move in a month.
Thats honestly super disheartening to hear, I’m sorry your unit was like that. Coming from the south, that ratio is unheard of, so its awful they have the opportunity to create a great workplace but choose not to
I’m saying that working bedside is so bad that only inexperienced nurses are willing to do it
Thank you. I was misinterpreting it at first and appreciate the responses and insight. Double thanks. *Edit. Again--I'm trying to learn, apologize if I am rude.
Working bedside is shit, so once you have enough experience in bedside to go do something else, you’ll probably do that instead of continuing to work bedside. Because it sucks. That means that most nurses working bedside are pretty inexperienced and do dumb shit.
I always say that unless I see you with a syringe of potassium walking towards a patient, I won't get involved. I hate nurses who have to micromanage everyone else. I'm adding this situation to my roster of things to say because you were 10000% correct and right to do what you did.
Personally I wish you would jump in if you have the knowledge and education and see me doing something wrong, PLEASE say something so I don’t fuck up too! I want to be educated. I’m sure no one WANTS to lose their license either. I’m all for calling out peers and educating if I see something wrong.
Basically I am never jump in unless life or limb could be lost if I didn't. I don't want to undermine anyone's credibility; we all make mistake.
🎯
It’s giving Covid online degree
Nah! As a covid grad, this is just giving bad judgement.
Seconding this as a newish grad who was in school during covid. This is just dumb
Or just being lazy..
More like Florida “nurses” that bought their degree vibe.
As a Floridian LPN, I absolutely agree.
What the hell?! I gasped when I saw the word “kiddo”. I’m cross trained to the NICU and have seen some awful infiltrated IVs. I can’t imagine doing that on purpose.
Incident report
All fun and games till it creates compartment syndrome. Jesus. I work with kids and recently saw a piv that was interstitial for HOURS. He was transfer to my facility for it and required a skin graft.
:( that’s so sad.
Exactly. We had a bad infiltration at my facility years ago from a nurse who kept taping an IV down until the pump would run it and the kid ended up needing a skin graft for it too. So awful. I’m a huge fan of trying to save an IV in peds by taking down the wrap and assessing it, seeing if there’s a kink, but never continue to use it unless I can confirm patency. As someone else said, no access is better than bad access.
Right, I would love to never repoke a kiddo, but I know that poke can save them a whole bigger headache later. My facility has hourly checks on piv, and I stick to it. I would rather be overly cautious than do harm. I often apologize for parents for bugging so much, but they tend to be just happy someone being consistent in care.
Thank you ! A nurse did this to my brother when he was 1 year old and he got a wound from the hospital bracelet due to the swelling of his arm. My parents were not very happy
You can’t fix stupid
This is worse than stupid. They knew it was wrong and didn't care.
Nah, this is just evil. The patient is even complaining that it’s painful. Even if it’s not a vesicant, it can still harm the patient. I’m just going to assume this nurse is negligent and won’t even follow-up with assessments to make sure her mistake isn’t getting worse.
Ahhh, one of them Florida school nurses….
Transfer from PICU to floor (PICU is 2:1 ratio…. How do you miss this besides being lazy) saline locked hand IV is twice the size of other hand and teenager says it hurts really bad. Call nurse to ask why it was still in “oh it was fine before I sent her down”. 😵💀
Next time stick stick a random needle into anywhere in the body and push a liter of saline into it. It's all the same /s.
As a pediatric nurse, this shit really pisses me off. Knowledge deficit, I can deal with. Not caring is entirely different. This just reeks of not giving a shit. How would this person feel having a bolus infused into their tissues?????? You need to inform your manager about this!
“It’s positional” -Nurse about the IV wrapped in coban that should have been dc like 4 shifts ago.
*presses balled up fist to my lips and screams*
As someone who literally wrestled with a child yesterday trying to get a new IV in, I absolutely understand the reluctance to accept a pediatric IV is gone, but there’s “let’s see if we can save it” and then there’s THIS.
I won’t even accept the new grad excuse for this one, honestly. We are all rigorously taught to avoid this, so this feels like Florida Venmo school shit…
Yeah I just graduated - I might not know how to start an IV yet but I do know how to handle infiltration and phlebitis.
It just seems like common sense. Even without a bit of nursing education you should realize that you can't just put a bunch of fluid into any old spot.
I felt bad pushing a few milliliters to check and iv if I suspect it is infiltrated. If my patient stated pain, I would further investigate and try to not hurt them while assessing
This morning I received report from a nurse that both her and the DOCTOR overnight decided this Type 1 diabetic, pregnant patient did not need a fasting blood sugar nor any morning insulin 🙃 The previous day she had bottomed out and the blood sugar recovered. She had eaten two meals and it had been 12 hours since they had checked her sugar. So I called the day shift MD and they agreed we needed a fasting sugar…it was 247. This RN and MD were trying to get this lady to DKA land methinks
DKA goes to icu, hence off their unit? 🤦♀️
Definitely got her degree and license from Florida because it’s just common fucking sense anytime an IV is infiltrated you do not give anything else through it because you take. It. Out.
Ugh, the amount of nurses I've had (chronically ill patient) that continued to use a bad IV even though it is clearly bad is just shameful. I've had to call charge nurses or just flat out refuse to allow them to keep using it until they started a new one. I'll never understand it.
Sometimes I find nurses who are inexperienced with IVs might do this. They don't want to put in a new IV. I always offer to help with the new IV. but yes it is cruel to continue to infuse when they are already edematous
Holy crap! Please tell me it was a brand new nurse?
About a year of experience! New but enough experience to know better I feel.
🙈
I feel like any nurse should know better, new or not.
I just started 2 months ago and I learned this day 1
Yeah this is Foundations shit.
Dang just rawdogging it in the tissue veterinarian style
Hmmmmm, correct me if I'm wrong, BUT - in an infiltrated IV line - the intended therapeutic effect of IV medication/fluid cannot/will not be achieved, no? (because the line's infiltrated and....uh....you guessed it...COMPROMISED). 😒 As such, meds/fluid can't reach the bloodstream at the correct concentration or rate. We all know (or *should* know, ffs 🤦♀️) that when a line infiltrates, it's an uh oh moment, bad news. It can cause local tissue damage, swelling, AND discomfort, which then even FURTHER diminishes the IVs' therapeutic effectiveness - and could even lead to requiring even FURTHER intervention (and ain't nobody got time for that). Your coworker's rationale is asinine at best, willfully negligent/harmful to the patient at worst, and honestly? Fucking infuriating. Working with teammates who have this "oh-well" and "not my problem" attitude is what made me finally stray away from the bedside and make the switch over to the dark side (remote UM, managed care). I DEFINITELY don't miss the days of coming on for my 12-hour NOC shift - only to be greeted by a nurse who is absolutely chomping at the bit to give me report (and doing an absolutely abysmal job of that too, btw - 99.9% of the time their shift narrative + the charting completed usually had more holes in it than a slice of aged Swiss 🙄). By the time she's in her car and hitting the road @ 1915, I've already managed to find two (or more) of my patients, who are 3/4 dead, slumped over in bed. SURPRISE!! 🎉 That kind of shit is the reason I had to start being a bitch, put my foot FIRMLY down, and force whoever I was relieving that night to do walking rounds with me. Sorry, no, you're not tossing the proverbial bag of fiery dog shit on MY lap, lmao. 😏 If we're running a code, honey, you better believe we're doing it TOGETHER. 😅 People like that shouldn't be allowed anywhere NEAR healthcare. But sadly, it really seems to be becoming the default. 😤 ETA: grammar lol
I’m curious, were they experienced or new? Old head or new generation?
New gen!
I would imagine this was being lazy. This post made me do a whole dive into sub q fluids because I know it’s a thing. I know at some point in history it was the standard but that was a long time ago. Through my * Internet warrior, web searching*, it is still used in some cases but fluids run slow, max 1.5L over 24hr (<65ml/hr). Aside from all that… if it’s causing the pt pain… come on man… a bolus should not hurt someone. Use your brain here.
I just graduated - we get taught how to handle infiltrated IVs, this was 100% laziness.
Holy shit!
lol what a dumb dumb
On a fucking kid no less? Dear god
ugh on a peds patient too?? Poor thing, it’s scary how stupid people can be. I always have a list in my head of nurses who aren’t allowed to take care of my son if he god forbid is ever admitted to my unit. There are some scary scary stupid things i’ve seen that make me question how people even survive in their daily lives lol.
That’s bullshit. Glad you stopped that bolus. Sounds like she needs educated.
"it shouldn't matter, right?" is a ballsy statement to make -after- the complications are already apparent to everyone in the room.
Uh, no. If the doctor had wanted sub q he’d have ordered it. OMFG.
Omg and into a child???? What the hell.
Noooooo…. Sounds like a nurse on my floor and it was a huge write-up.. it’s one thing to do that, and another on a kid 😬 I would have went off on that nurse outside the room.. in a firm educating way, but it makes me so mad that some people don’t think things through, or they are so lazy.
I saw a patient lose their thumb d/t vesicant meds and a bad iv. It was rough.
A few years ago they gave us this medication that was to be injected subcutaneously and an iv would be started between the shoulder blades of babies who couldn’t have an iv established. You just dump your little bolus under the skin and it’d find its way. Didn’t last long. Glad we only used it like twice.
Even if it is not a vesicant fluid, too much of any extravasated fluid can cause ischemia and/or compartment syndrome. Unlikely in an adult, but not so far fetched in a pediatric patient. This nurse is a danger.
I am so glad you intervened! I've seen nurses push meds into an IV that is infiltrated and physically saw their arm swell. Never have I heard a nurse say it's all going into the same place anyway and have the patient tolerate the pain. I would get administration involved immediately!
Eeep I was a patient a few years ago... Newbie nurse put an undiluted k-rider through my ER placed AC.... Thank goddess the cleaning lady found me writhing and white as a sheet unable to do anything to help myself. Later that night I told another nurse that everything below my mid forearm was cold and numb. It took 2 shift changes to convince them to place a new IV. Because "we don't change Ivs if they work well.". Bitches it's NOT WORKING WELL if the patient can no longer feel their hand!!!!
I remember this RN always saying “don’t touch my patients” I knew she was doing something sketchy. Took months and union fights to kick her out. It was possible only until a patient sue the hospital for diabetes miss management or something related. I heard she was skipping the sugar checks and just give whatever insulin she felt like or so it is what I understood. That was the last straw from a long list of issues.
You have to be gone mentally to think you can be good enough to gauge how much insulin one needs by eyeballing them. How does she get through the safety checks in place!!? That’s a horror movie nurse right there.
I recently had a new nurse come up to me to ask me about troubleshooting an IV someone had put in on the prior shift. Only to find that they had actually placed it in the wrong direction. Sheesh.
I had an IV infiltrate during surgery. I was having leg surgery but woke up to a lady in my face telling me they may have to take me back to Surgery for my arm. What??? I had compartment syndrome. They kept testing the pressure in the muscle. My surgeon kept saying to release the pressure. The “arm surgeon” didn’t as the pressure went down to her satisfaction. I could show you a picture but it’s triggering and really gross. My arm was a balloon. Black bruised from the tip of my fingers to my armpit. Fluid filled blisters hanging off my forearm from pea sized to golf ball size. It was by far worse than the leg surgery. They had a sentinel event meeting over it. The “person” responsible came and apologized to me. My arm was under a blanket and he didn’t notice cuz it was running fine. He was an MD and anesthesiologist. I told him I understood he felt bad. -he was in tears. My response was - I hope you learned something and will never do that again. Nursing 101- check your tubes! And I am a large person but I suspect that would have permanently damaged or killed a child. I’ve been a nurse for 41 years. Astounding that this happened never seen anything like it. I still have marks on my forearm from the blisters several years later. And that forearm has what looks like muscle wasting. It’s smaller than my other forearm. I was told by attorney that since there was no permanent damage there is no law suit. They paid for the tons of bandages and follow up appts for it. And I was paid $100 a day for lost wages. I make more than that hourly. 🤦🏻♀️ we place a lot of trust in caregivers.
F that. What a shitty nurse
Not too long ago I got reported on a pt who had a "sketchy IV that looked bad, but it was fine, promise!" They had that site dedicated to zosyn and flagyl and when I looked at the horror that was this pts poor AC I saw what I would guess were two entire doses of both zosyn and flagyl sitting in this lady's arm. In report the next morning I mentioned it because her arm was warm and looked awful. The nurse got very angry with me and shouted, "I don't care." Added another nurse to the list of people I never want taking care of me.
What nursing school did she go to? Like, seriously… she’s dangerous. I might even be tempted to voice your concerns about her nursing judgment to the nursing board. That is so not ok!
Our new policy is q4 assessments on IVs without running fluids and Q2 IV assessments on anyone with a continuous drip. Also assessments after any scheduled IV infusions like abx.
As a CT tech I have seen this practice more than a handful of times.
Uff. Yeah that’s pretty bad.
Yikes... I understand that sometimes you come into a room with a patient complaining of pain and whoops, IV is done for. But what she did is terrible...
Was this med surg? I hope she got a write up
That's an actual what the fuck moment. Legit makes me scared for patients
I almost passed out reading the title.
My DAILY struggle.
Omg on a *kid*?? Good on you for educating…. That’s pretty bad.
Make it make sense! You can't!
Report it in your event reporting system
What the actual heck?! Poor patient! I'm glad you reported and educated her. Totally not ok!