G’day team,

Today I’m writing to partially to enter @Sco ‘My shittiest method’ competition, but mostly to rant about a long month where I exploded a lot of veins. Quite apart from a lot of the other entries in this contest, which focus on complex, out of date or difficult methods, I’ll be focusing mostly on my own ineptitude... so let’s get started

What is PIVC?

You know when a nurse or doctor stabs your arm with a needle and then expertly pulls some blood out… that’s called venepuncture (puncturing the vein), if they leave a small tube in your body so they’ve then got easy access to the blood then that is PIVC.

Pretty simple right? Well maybe for an expert, but as a novice, this has been the bane of my existence for the last five weeks.

My Dilemma

Five weeks ago I arrived on my Rural & Remote Medicine placement in the little town of Biloela, a small ~8000 person community in Queensland, with the closest tertiary (read: proper) hospital about 200km away

The great thing about being sent to a tiny hospital is the chance for hands-on experience. In a big tertiary centre I’d be lucky to take a blood pressure. In Biloela I get to suture wounds, pull toenails, take bloods and even assist in surgeries. It’s here that we find our problem, the enthusiasm of nurses to find me opportunities to practice cannulation.

The Cannulation Method

Any doctor or nurse will tell you, cannulation is pretty straight forward. While Medical School will always teach you some convoluted method with three changes of gloves and a few sets of hand-washing, over the last few weeks I've developed my own unique method for PIVC.

1. Get your patients arm, find a vain that’s straight and large (oh… and visible and palpable and not bifurcating and with no valves or local damage or infection or proximal IV lines or attempted lines or history of mastectomy for women).
2. Get a nice needle, usually a 20 gauge which is about the same size as the vein you want to enter
3. Get a few other things (a ‘Bluey’ (sheet), two alcohol wipes, two ‘dots’, a bung, a sticker, a tourniquet, gloves, tubes for the blood you need)
4. Gloves on
5. Right about now your phone will ring and you’ll have to let it call on as you can neither answer it or mute it
6. Tourniquet to let the veins engorge
7. Fine a nice juice one (again following all the rules above)
8. Uncap needle
9. Anchor vein with left hand
10. 15-30 degree angle from the skin, enter
11. Progress till you see a flash of blood enter the needle
12. Realise that was just a trick of the light
13. Start sweating
14. Keep pushing? Maybe the vein is deeper
15. Patient starts wincing
16. Pull back, no way it’s 2cm under the skin
17. Maybe a little left or right?
18. Go left, nothing
19. Go right, nothing
20. Patient is looking at you like you’re inept now
21. You’re feeling pretty inept
22. You are inept
23. A friendly nurse will come over and encourage you 
24. You pull out and try again
25. Anchor the vein, enter a little further up
26. This time it feels great! You’re going to get it!
27. You see a ‘flashback’ indicating you’ve entered the vain!
28. Next step is to pull out the needle, while progressing the cannula. This will leave a small plastic tube in the vein but get rid of the metal…

Image source

1. But the cannula won’t progress?
2. You push a bit harder
3. Nope
4. So you push the needle a little further in? Maybe you’ve just hit a block?
5. The cannula goes in, slowly…. but it’s a little tough
6. You look down
7. The entire region is swelling up
8. Fast
9. It’s already the size of a marble... now the size of a golf ball
10. Fuck!
11. You’ve burst the vein! Absolutely obliterated it
12. It’s carnage
13. Blood is everywhere
14. You look down! Your ‘bluey’ or sheet that you prepared you didn’t actually put in place
15. The patient is hemorrhaging on the bed
16. The correct order here is 1) remove tourniquet, 2) pressure on wound, 3) remove needle
17. You panic and pull the needle out, blood goes everywhere, you start pushing on the wound with a small ‘dot’ band aid but you may as well be trying to stem a river
18. The patient is moaning in pain now
19. You almost needle stick injury yourself while putting the needle away
20. The patient is crashing! He’s gonna die!
21. Blood is everywhere, smeared over his arms, your arms and somehow the walls and roof as well
22. The nurse called the Medical Emergency Response Team
23. They rush in and see you with a needle! They just assume you’ve come in AFTER the emergency and started getting intravenous access
24. The head doctor (probably the head of the hospital who’s also personally in charge of your mark for this rotation) tells you to get intravenous access ASAP!
25. You freak the fuck out.
26. You’re not screwing around this time
27. You take a handful of needles and just start stabbing the patients arm everywhere
28. A sturdy up and down striking motion ensures that somewhere, somehow you will get access to a vein even if it does explode in the process
29. The Medical Response Team looks on in horror
30. Finally a needle slips into something
31. You let loose a sigh of relief and progress the cannula, step back and look at the abhorrently dismantled remains of your patient arm and smile at your cannula
32. Suddenly your cannula blows out followed by a jet of blood! Fuck, it was in an artery, not a vein!
33. The police arrive and take you into custody
34. The patient dies
35. You make your one phone call to your girlfriend… she says she tried to call you earlier.
36. She’s pregnant
37. With twins
38. They’re your best friends.
39. Your cellmate is a Nickleback fan

As you can see the whole process can be quite arduous, and I’ve been through this about eight times in the last five weeks. So next time a nurse or doctor confidently and quickly draws blood or places a line in one of your veins, be very thankful for their immense skill.

Thanks

Thanks for reading team! I hope you had fun :p

-tfc

---

---

steemstem

Get involved today!