Thursday, May 27, 2010

Hazards of the NICU

So, I've been on my own for a while now at work. No one to report to, no one coming behind me and making sure I'm doing everything. Which in a sense has been a welcoming breath of fresh air. After six months you reach the point where you either know it or you don't and they just have to let you take off your swimmies and you're either going to sink or swim in this job. So far, so good - I must say in the metaphorical sense, that I am a fairly good swimmer - sure every now and again I start to sink a little bit and forget to come up for air, but then I quickly remember and doggy paddle my little heart out to make up for it, and all is right in the infant world again. Well last night was my first real 'oh shenanigans' moment - I use shenanigans merely as a censored word because there's really no other way to describe the sinking feeling that comes over you when something unplanned happens to your patient who happens to be a 32 week old preemie. Everything in you drops, and all you think is 'oh shenanigans' and you stop thinking, you just start doing. Now the way I've described this so far you must be thinking what did she do - drop a baby!? No, I didn't. As a disclaimer, the baby is fine, I've been calling to check on her all day. If you have a weak stomach, just scroll over and avoid the picture....

This is a peripheral intravenous (PIV) infiltrate - we use PIV's to give TPN (nutrition), blood, antibiotics, and a number of other things. My little patient was getting TPN and lipids through her PIV - both of which are caustic to surrounding tissue when the IV for whatever reason is no longer in the vein. And the following can happen - 

My baby's IV infiltrated. At 6am. It happens, as often as you check the site it just happens. Lucky for me, I caught it (later then I would have liked) and stopped the fluids, got the nurse practitioner, gave a few injections of hydase (it helps the body absorb medications), got another IV, restarted fluids, all with the help of a really good roommate (couldn't have done it without her, she actually did more than me while I just tried to keep it together praying please don't let them fire me, please don't let them fire me), and all the while with the charge nurse, both nurse managers, the nurse educator, nurse practitioner, the fellow, and respiratory therapist at the bedside. Nothing like an audience when all hell breaks loose at the end of your shift. Good times my friends, good times. I then finished my shift, gave report, and went and had a nice little chat with my nurse manager and nurse educator. Even better times my friends, even better. It was a good chat, they reassured me that I am a doing a fabulous job and that I am a great nurse, and lo and behold this does happen to everyone (nurses that is) and it could've been and has been so much worse in other instances. It didn't do much to make me feel any better, and I just cried and cried, and they knew there wasn't a whole lot they could do to make me feel any better, and I knew they couldn't do a whole lot to make me feel any better. So with a supportive we're here for you and you can only grow and get better from this experience - I left work to come home and crash. I called tonight, and luckily it is looking much better and the baby is fine and the parents are fine. Sadly I personally can't always be perfect and I'm pretty sure that I will never forget this experience and as much as I shudder at the "you can only grow and get better from this experience", it's true, and I can only move forward and hope to be that much better of a nurse in the future and hope and pray that it doesn't happen again - anytime soon anyway. And it's nothing that a nice couple of days off and some retail therapy can't cure!

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