Running Head: Critical Reflection 1

Critical Reflection

NURS 3020

Bethany Carr

Trent University
Critical Reflection 2

During my second shift at Ross Memorial Hospital I was assigned to work with a float

Registered Practical Nurse (RPN) Jane (pseudonym). Jane had six patients for her day shift; one

independent, three one person assists, one two person assist, and one complete assist using Hoyer

lift. Jane let me pick the patient I wanted to work with for the day, she stated that it would be

boring working with the patients who were independent or needed supervision. She showed me

her patient Barb’s (pseudonym) worksheet and said I could get lots of experience working with

her; I was eager, so I agreed to Barb. Barb had an NG tube, peripheral IV and a Foley catheter.

Jane left me to prefer my vital and head to toe assessment on my Barb, where she was alert but

not oriented to place or time. After I finished AM care on Barb, it was my day to administer

medications with my clinical instructor, Barb receives them through her nasogastric (NG) tube.

Along with the AM medications, we were to flush Barb’s peripheral IV with a saline flush. We

were not giving an IV medication, but it was running to keep vein open (TKVO). My clinical

instructor guided me through the procedure of the flush and completion, IV was patent and

flushed well with no resistance and with no signs of complications or infiltration. I continue to

check on my patient throughout the morning, and help Jane with the rest of her patients, she is

new to the floor and I feel like I’m bothering her because she is trying to find her way on the

floor and I am trying to see if she needs help with anything. After I return from lunch, I check on

my patient whose feed has gone from 700cc of water to around 200cc of water in three hours.

My patient is supposed to only receive a flush of water, 180cc, before and after meal. I notify

Jane, and she tells me to confirm with my clinical instructor that there was 700cc to start, upon

confirmation from my instructor I re-notify Jane. Jane goes to the pump and sees it has been

flushing 180cc but every hour. She tells me to speak to the Registered Nurse (RN) in charge,

after waiting 30 minutes the RN states there is nothing we can do, and we need to notify the
Critical Reflection 3

doctor she received a little extra flush, 180ccs. While this has happened the patient’s, daughter

comes to find me to let me know that Barb’s arm looks odd. Upon inspection I can see that

Barb’s IV has infiltrated, and I notify Jane. Jane comes to the bedside and speaks with the

daughter who says she has seen this happen a lot with her mother. Jane then tells me that we

need to remove the IV and insert another one, but she will not be doing the venipuncture and we

will have to wait for another nurse who isn’t busy as she is “not very good at it”. It is then past

our scheduled shift time and Jane tells me I may leave because she is going to have to wait

anyways.

After this situation on my second day I was feeling nervous and anxious. Wondering how

and why it happened, and curious how to avoid these things in the future. In regard to the feeding

pump, it is an easy fix for my future, better this I had never used a kangaroo feed pump, or one at

all for that matter. In this case I now know to double check the flash amount and rate as well as

the feed rate and amount, a circumstance where I believe you just have to make the mistake once

and you forget to check again. Learning how and why infiltration happens can help me in the

future when I am administering IV drugs and tending to patients who have an IV. Making sure

that I know early warning signs and assessments to do will help prevent IV complications.

Hadaway (2010) stated that:

Recognizing the early signs and symptoms of infiltration can limit the amount of fluid

that escapes into the tissue. Such signs and symptoms include local edema, skin

blanching, skin coolness, leakage at the puncture site, pain, and feelings of tightness.

I knew about these assessments and that checking the IV site is important, but now that I have

seen a complication and how quickly it can happen I think I will be more aware of the

importance of checking the IV site and making sure the IV is in situ even is just TKVO. It will
Critical Reflection 4

be especially important in patients who are more seriously ill who cannot themselves tell you if

the site is sore or swollen.

The reason why I chose to reflect on this event is because it was the first thing that I

really thought went “wrong” when at placement, I didn’t feel overwhelmed at the time at the

hospital, but I did have feelings of being helpless because I needed the help of others who had

their own things to worry about. I am thankful my clinical instructor is easy to reach and

approachable if I am having issues, I felt bad like it was my fault towards my float RPN and how

it had caused work for her and another nurse now. Though this caused me to be stressed after my

second shift and nervous to go back after talking to my friend who recently graduated, helped me

see it as a learning experience and that everyone has to learn somehow and sometimes it is

through mistakes. Though the flush in the feed ended up resulting in a minor mistake the doctor

was not worried about, it still gave me the opportunity to learn more about the pump and how it

works to avoid later mistakes. I have not experienced another event like this because this is the

first time I have had a patient with an IV or NG tube, and I therefore hadn’t had experience

besides in lab which is sometimes hard to compare to in practice. In future practice I will be

more aware of checking IV sites in my head to toe assessments, I have made myself my own

worksheet where when I finish my cardiovascular, respiratory, and gastrointestinal assessments I

have IV written. Though this will become habit with practice, I just need to maintain a routine

that works for me, that can help me to efficiently and comprehensively gather all my needed

information.

Overall, this situation and reflection into it opens up my eyes to the importance of

becoming familiar with the machines at your facility, as well as the importance of checking and
Critical Reflection 5

maintaining a patent IV site to avoid complications for your patient and therefore making things

for you and future nurses with this patient easier.

References

Hadaway, L. (2010). Protect patients from I.V. Infiltration. American Nurse Today, 5(2).

Retrieved February 6, 2018, from https://www.americannursetoday.com/protect-patients-

from-i-v-infiltration-3/.