It’s an overcast chilly day in Chicago, just the kind of day for a good joke. And I got one this morning from a former nursing student at Trinity Christian College, now a seasoned grad. She’d had a “crazy” day yesterday. Here’s why:
Our primary IV tubing is on back order. This means we can’t use our IV pumps. I’ve never not used a pump. DRIP RATES? Seriously.
Did she expect my pulse to race in sympathy? Not a chance. Instead, my mind raced back to a PM shift in the 70s. I’d started that shift on my usual floor – twenty-eight med-surg beds. Half-way through report, the PM supervisor “floated” me to another med-surg floor. Thirty-two beds. Starting report late—it was oral in those days, given by the day nurse in a conference room—got me off to a frazzled beginning.
I walked out of report closer to 4:00 than 3:30, and bee-lined to make rounds, just to make sure all my patients were in their beds and breathing. As the only RN with four aides, I was especially worried about the eight post-ops, with more to come back yet from surgery, plus the eleven IVs to monitor. (Yes, monitor means to personally count the drip rate of each one.)
My rounds were cursory. In bed, yes. Breathing, yes. Bleeding, no. IV infiltrated, no. IV bottle (yes, glass, no plastic bag), marked with adhesive tape by day nurse with the amount out at 3:00pm, yes. Right drip rate, yes (i.e., x number of cc’s per hour to have a 1000cc bottle run for a specific time period). Good. On to next patient.
Just routine rounds. Fly, fly, fly. Fly back to med room and start setting up five o’clocks. 9-1-5-9 meds. No unit dose. No med carts. Cafeteria-sized aluminum trays papered with medication cards color-coded for time to be given. Phones ringing, no unit secretary.
Is your pulse racing yet?
I worked in overdrive the whole shift. More post-ops came back from surgery. In a really stupid policy move, the RN on the floor had to go to the recovery room to accompany the patient back to the unit. I’d think how dumb that I was leaving thirty-some patients with four aides while I’m gone for at least fifteen minutes to make sure of the safe arrival of one patient. I prayed for no emergency.
Back from surgery, I’d have orders to note, doctors to call, nine o’clocks and sedations to set up. In the flurry, as I made my after supper rounds (only there was no time to go to supper), I stumbled over something next to a post-op’s bed. Pushing the bed curtain aside, I got that sudden feeling of a boulder crushing my chest. Checking my feet, I saw the familiar crossbars of an IV pole. Slamming the curtain way back, I saw IV tubing leading to the patient’s arm. An IV I didn’t know about, hadn’t checked.
The bottle was dry. Empty. Blood backed up in the tubing at the insertion site. Bad enough that the IV would have to be dc’d and restarted, but bad also, of course, that the patient had gotten them too quickly. The tape on the bottle, so much out at 3:00pm, indicated the bottle was supposed to run most of the PM.
I hadn’t been told about this IV in report. And clearly, the day nurse had not counted this drip rate correctly, or had counted it when the patient’s arm or tubing were a bit bent, so that the IV went whoosh when they were straightened out. I still choke in horror thinking the patient could have died if all 1000cc’s (about a quart) had been infused within minutes. Then I might have found the patient cold. And dead.
The fear of IVs gone awry lives on in my bones today. I was happy to read my former student’s solution to her drip rate counting dilemma:
Found a new website www.rncalc.com.
In my day, that information on how to calculate drip rates was in our heads. No smart phones then.
When I asked if I could use this incident for a blog post, this nurse said, “Yes, you may quote me, but you have to try to feel a little sorry for me.”
Sorry, did you say? No way.
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Write Along with Me 
Lois, I was sort of caught, era-wise, between the tapes on the side of the bag and IV pumps. I sort of think different hospitals had invested in the ‘new fangled’ technology and because I often worked in different hospitals, I was exposed to MANY different administration systems.
But, I did like the tapes; not because they were hared, but they gave me a sense of control, and they challenged my mind and organizational skills. How, organizational skils? I had to be organized to make the time to go assess for infiltration, positional IVs, IVs running ‘ahead’ and there was much less of that with the onset of pumps. I was more responsive and had more interaction with my patients. I liked that.
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That sense of being in control. Yes, that was nice. Remember shining the flashlight on that strip of tape in the middle of the night? And I hadn’t thought of the idea that you see the patient less often with the pump. A real downside!
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Oh Lois..in one blog moment you have taken me from here back on shift in the 70’s…sounds like we came from the same place…what a trip down memory lane!
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We must be! Aren’t they fun, if not harried, memories? It’s hard to believe how much has changed, but we still did a great job of saving lives. Thanks for chiming in.
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Yes, we did a lot of ‘life=saving’ but that leaves today’s nurse who has the pumps and pocket PDAs and other bells and whistles MORE TIME to save lives. I see a positive to both ‘arguments.’
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Absolutely, and, hopefully, that includes more time to spend at the bedside.
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We had our pumps recalled this summer. I went around and gave the staff information on using burettes and the dial a flow. The “older nurses” said “sure” and walked away. The newer nurses stared at me with blank looks on their faces. They could not function without a pump. Don’t they teach this in school? What would we do in a disaster, like an earthquake or tornado and you had to fly by the seat of your pants with no power?
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How frustrating. I’ve been retired eleven years, but calculating drip rates use to be covered in the pharmacology course. But, I can see, if grads never encounter the need to use that skill, it would get buried in their brains. Reminds me a bit of students in my doctoral stats courses in the late 1980s that couldn’t do basic computations without a calculator. They saw us older students as some sort of aliens, and, in return, I needed their help with the multiple functions on a calculator. Thanks for writing and welcome to WP.
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A f/u to my earlier reply. I’ve checked with my “source” and she said both young and older nurses knew how to calculate drip rates, but it was those in between, she agreed, who seemed to have it buried in their brains. Then I checked with a senior in a baccalaureate program. She said she has earned it and knows how but has not yet seen a need for it in her clinical practicums. So, good news, it seems like calculating drip rates is not a dead art, but just lost for some…and then, with some coaxing, retrievable.
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Oh, yes, do I ever recall checking drip rates – mostly in the 60’s. But this was on peds units with burettes and micro-drops and rates like 10 or 20 mls/hour. And I recall having IV check sheets where we recorded the hourly amount in and had to make sure everything balanced out at the end of the shift – don’t remember details. Don’t recall ever hanging a 1000 ml bag on peds. I remember having a terrible time switching to pumps – just didn’t trust them and then when they started beeping – oh my!! And I was trying to teach students how to use them!!
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How funny. Like the blind leading the blind. I never had to teach or work with pumps because we had no IVs on psych and beginning students did not have IVs yet when I was on ortho. Patients had pumps, though, and I just hoped they wouldn’t start beeping. Nothing like being an experienced nurse befuddled with technology! So glad I never worked peds, except for one horrid float experience. That may become a blog post someday. Fun memories, Cynthia, now that we sit nicely retired.
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