Hi everyone! I'm a 2nd year resident doctor in an inner city hospital. This is a blog to document some of the experiences I encounter as a training doctor, and some of the things that I learn in the process. After all, being a physician means that I'll be learning some fascinating topics for the rest of my career, and seeing how I can use those to help patients.

Let's get started with today's experience:

Peripheral Lines

Peripheral lines, known by the general public as IVs (intravenous) are lines placed into the veins, usually in the upper arm, forearm, or hand, in order to provide a route for fluids or medications to enter the bloodstream. The blood carries the medications or fluids into the organs that process or require them.

Peripheral lines are considered one of the most difficult non-surgical procedures to do. It's been said that if you can master peripheral lines, everything else becomes much easier (a lot of other procedures have a lot of steps, but the technical skills required to successfully place a peripheral line tend to be pretty advanced and have carryover into many other procedures). Oftentimes barriers to and difficulties in placement include, but are not limited to: fluid inside the arms and hands, fat layers, calcified veins (atherosclerosis), collapsed veins, bruises, elastic veins that are hard to penetrate, and veins that move around a lot.

My colleagues and I tried to place a peripheral line on a kind lady on whom some others had tried, including a few nurses. We used an ultrasound machine to try to find a good vein where we could place the line. She had pretty elastic veins, so although we exercised good technique in localizing the vein and bringing the needle into the wall of the vein, we couldn't penetrate through the wall despite hitting the target. We spent a while trying and the patient needed a break. Thus, our temporary solution was to switch the routes of certain medications until the next group of doctors could give it a try.

Adhesive Capsulitis

The same patient had adhesive capsulitis (for laypersons, frozen shoulder or stiff shoulder) on the same arm that we tried to place the peripheral line. As a result of holding her arm in place, her shoulder became somewhat stiff and painful. Having had some experience in physical manipulation of tissues, on the spot I decided to assist her in some exercises to loosen her shoulder and pump up her arm muscles a little bit. These types of exercises tend to help keep adhesive capsulitis under control.

The benefits of kindness

While performing this bit of therapy, I listened to the patient and watched her to ensure that she wasn't in significant pain or discomfort. I stretched her arm and shoulder to a greater range of motion than what she had before I came to see her initially. She was able to use her arm quite effectively right after this treatment and she was very grateful for the time and attention.

Small actions which take a few minutes can truly improve a patient's experience while they're in the hospital. Few people actually want to be there (there are exceptions to everything!), and if there is sufficient time available, these small actions can make a big difference in their stay and their attitude towards the staff. Sometimes I simply do not have a single extra moment in a 12+ hour shift to help the patient the way I'd like, and in such cases I remind myself that I cannot overextend my efforts beyond my capabilities. After all, doctors are not Gods; we're simply humans.

I hope you've enjoyed this little snippet of an experience I had as a resident in an inner city hospital. I'll have many more stories and learning experiences coming in the future, so stay tuned.

Sources:

Here are the previous editions of this blog:
Chronicles of an Inner City Hospital Resident Doctor #1

Chronicles of an Inner City Hospital Resident Doctor #2

Peripheral Lines

Adhesive Capsulitis

The benefits of kindness