Saturday, March 04, 2006

Cuts

In a comment to my last posting entitled “Jane”, paedsrn – author of the blog geeknurse – expressed his surprise and dismay at the fact that they cut off part of her ear. I agree that it is cringe inducing, and we were not at all happy that it happened. But it is not the only time that I have seen parts of a body cut from a baby. I once saw a piece of cheek cut from a neonate, and when I was a resident a nurse cut off a tip of a finger of a toddler. In each case a nurse was cutting some tape. For the cheek and ear removal, they were cutting tape that held an endotracheal tube in place, and for the finger they trying to remove tape and gauze that held an IV in place.

Are these mistakes excusable? No, not really. We who work in the NICU always have to be mindful that little things can make big differences in little babies. If you’re cutting tape that is on a baby you have to always know where the tip – and every other part - of your scissors are. Better yet, cut the tape the right length before putting it on the baby’s face, instead of afterwards. Unfortunately, though, sometimes one has to make a mistake like this to learn how picky you have to be around neonates. Fortunately the majority of us learn it without having to cut off some flesh.

What to do with the person who cut off the body piece? In my experience the perpetrator is so horrified that no disciplinary action can punish them further than they are punishing themselves. When I was a fellow in neonatology, I cut my forearm in a cooking accident badly enough that it needed stitches. I went to the emergency room of the same hospital where the tip of the toddler’s finger had been cut off, and who should be my nurse but the very one who had cut off the toddler’s fingertip. Frankly, I didn’t even remember her - it had been a couple of years since the incident. But she clearly remembered it (of course) and told me her gratitude that I, the toddler’s physician, had recognized her mortification and hadn’t raked her over the coals for it. It was weird: an incident I barely remembered had had a huge impact on her. I still kept a pretty close eye on her, though, when she pulled out her scissors.

What to do with people who twice cut off a piece of a body? They have to go. Fortunately, I’ve never seen that happen.

11 Comments:

Blogger wunderkind said...

A resident made a cutting error this week.

What is the unit talking about? The error - yes - - but more importantly the way the head responded. i wasn't there, so to a certain extent what i am reporting could be considered *gossip*. On the other hand, what i am reporting is the response of the ones in the room when this was confronted.

When the *boss* discovered this error, the one was called in. This one was reamed out in front of their peers, parents and the nursing staff in that area.

Yes, all say that it needed to be addressed.

All are also saying that it was handled totally wrong.

This person is one who has the highest respect of those in their class. Mistakes happen with the best of us. Lessons learned.

But to rub ones face in it?????

This story won't leave the unit for several months. Remembered most not by the mistake of the cut but by the reaction of the boss.

9:09 PM  
Blogger Flea said...

Okay, my anectdote:

A NICU nurse cut a premie's upper lip removing tape holding his nasal prongs.

She was a very experienced nurse and she was absolutely mortified.

I'm surprised this doesn't happen more often.

best,

Flea

9:30 PM  
Anonymous Maggie Rosethorn said...

Many years ago now, I nearly cut off a neonate's finger removing an IV from their hand. There was so much tape on it I couldn't remove it by hand so resorted to cutting. As you said, it is horrifying to the person who made the error, and one you NEVER forget. My bosses were very gentle with me, and the parents, luckily, were kind when I went out, in tears, and apologized to them. You can be sure that after that I was VERY careful as to what I was cutting.

The incident is over 20 year ago and still haunts my dreams.

9:45 AM  
Blogger Dream Mom said...

Perhaps we need to take away the scissors from the nurses:)

I haven't witnessed any nurses cutting anything off my dear son but I can tell you that I wish the nurses would be as diligent about using the adhesive remover on my son as they are about taping. It's quite a mess to try to remove it after every hosptialization. I now require them to remove all adhesive prior to discharge. It may sound picky, but you have to understand how many hospitalizations he's had.

As for cutting someone, I think the trauma of actually cutting someone is enough punishment.

12:42 PM  
Blogger wunderkind said...

dream mom, "but I can tell you that I wish the nurses would be as diligent about using the adhesive remover on my son as they are about taping"

i love the adhesive remover and i use it faithfully. i am surprised at how many don't use it. i agree with you and personally think it needs to be protocol.

2:32 PM  
Anonymous Anonymous said...

And then there`s all the lunatics cutting off half of most neonates penises. Bizarre!
Sorry, as a mom who has had to fight to protect her boys right to leave the hospital in one piece, I couldn`t resist.

It is pretty understandable that pieces get cut when removing tape. I`m sure that must be a horrible feeling for the nurse or dr.

2:50 PM  
Blogger neonataldoc said...

Interesting comments all, thank you. Wunderkind, I said "ouch" when I read the part about the scolding in front of peers and others. Anonymous, I know circumcisions are a serious subject, but thanks for the laugh anyway.

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