Of needles and nerves
May 3, 2007
“Good day Mr. Sunshine*, now you need to have an IV (intraveneous) drip put in and this medical student needs some practice…”
There is always a split second of uncertainty before the patient semi-reluctantly utters “okay”. Either that or I’m delusional.
Don’t get me wrong. Not all patients are like that. Some are more than happy and in fact very inviting for us medical students to have a stab (hoho pardon the pun) at putting an IV drip/doing a cannulation for the patient. Some just inhaled sharply by reflex and shook their heads vigorously. Some just look at you blankly.
Bit of background info: The purpose of an IV line is to create an open communication to the patient’s blood vessel (vein in this case) for the purpose of infusing either fluids, medications (some drugs are only meant to be administered intravenously as they could be inactivated by the liver/stomach post-ingestion hence needing to bypass the digestive system), or blood products (transfusions). IV infusions are also used when fluids/medications are urgently needed as the IV provides a direct access to the body’s circulation. Okies that’s the lil’ bit of info.
I’m currently in a pretty busy ward and have the good fortune of practicing doing a few IV insertions (usually the interns does them, but they’re always happy to let medical students have a go…that takes one mini item off their humongous to-do list) these past few days. Not every patient is the same of course; some pleasant, some not so pleasant. To be honest, I don’t blame the latter because…well being in the hospital is not pleasant to begin with, ya?
Let me recap the scenarios on my recent attempts. Some are the usual, some are funny at first sight, some are not funny till you have a think about it when you get home, while some are definitely not funny at all.
Patient 1: Mr. Sunshine*
Mr. Sunshine’s an elderly Italian gentleman who was sitting by the room window admiring the sunshine outside when I knocked his door. He seemed really nice and understood that I’m a med student who’s gonna put in his IV line for him. He speaks mainly Italian and luckily we got by with basic English. This was my first attempt in quite some time so I was a lil’ bit anxious and the Mr. Sunshine was reassuring me on and off (I thought I’m the one who’s supposed to reassure the patient, hah!). I needed two tries before I finally manage to secure a patent IV line on Mr. Sunshine. At the end of it all, he was genuinely happy for me and even did a little clap. I thanked him for bearing with my inexperience, and suddenly he leapt out of his bed and beckoned me to look out of the window. “Look, look!” he said. I looked. All I see were random houses and trees. “No..look look, big tree!”. I peered out of the window again and yes indeed there was a hulking tree roughly a few miles away. I looked at him and said “Oooh big tree…” He beamed and pointed to himself. “My house!” I did a double take at the tree. After a few “my house” and “big tree” turns out that he was happily showing me his house, which is not visible from the window except for that huge tree in their backyard. I patted his shoulder and grinned. “Nice house”.
The following day a staff member informed me that the cannula (drip line) I used was a tad too small. It was actually meant for paediatric patients. Oops. At least I now know he is a proud owner of this sprightly tree in his backyard.
Patient 2: Mr. Now You See It Now You Don’t*
This patient is interesting. He was curled up in his bed when I approached him with the trolley full of IV equipments and asked for his consent to put a drip line in. He agreed and laid on his back while I set up the materials. I took a few minutes to prepare the antiseptic swabs, cannula, etc and then promptly pulling the blanket away from his arms so I could find a suitable vein. Then it struck me.
The patient has Parkinson’s disease, which means he has a tremor. I did not notice at first as both of his arms were under the blanket when I first arrived. It was when I went inspecting his arms that’s when I notice the tremor (and it is pretty noticeable too). I put on my gloves and took a deep breath. Alrighty, just do it. Tourniquet (the adjustable band that goes around the arm) on, my left hand held his arm down firmly while my right hand was hovering over his vein with the cannulation needle. The only equivalent that I could think of to describe how it was then was to imagine trying to insert a needle into someone’s vein while the both of you are inside this car along a road riddled full with pebbles and rocks. The vision is bumpy and soon I had to stop to laugh cause I realized my head’s starting to bob a little in sync with his tremor.
Ah, the attempt was successful. The best part is, I was focusing so hard on the procedure that I didn’t realize the patient has fallen asleep throughout it all. You could stick a needle through this guy and he’d be snoring away. What a hero.
Patient 3: Mr. Moody*
I didn’t think too much about it. I just wheeled the trolley right to the patient’s cubicle and set up the stuffs. Just as I was a bout to draw the curtains around the bed, a nurse poked his head between the curtains and said this:
“Let me know if you need help holding him down.”
Beautiful. I certainly didn’t expect that. I soon found out that the reason why I had to put in a new IV drip for him is because in an agitated and volatile state that morning Mr. Moody became something akin to the Incredible Hulk and ripped off his IV lines. Well, work still needs to be done so the show must go on. Mr. Moody seemed alright when I explained to him that I need to put an IV access line on him. Unfortunately, his patience and courtesy deteriorated after two non-patent lines (in other words, failed attempts) and he started muttering something in Greek (he’s Greek) in a not so pleasant tone. I actually intended to give it another go when the image of the Incredible Hulk flashed through my mind and I thought okie I tried, now lemme go get someone more senior and experienced to take over.
I grabbed the intern and told him sorry nope can’t seem to get the line in and I would appreciate it if he would show me how he does it. The intern spent some time telling/advising/coaxing/pleading with the patient not to yank it out again this time round. Patient agreed and the intern prepared himself for the procedure. He whipped on his gloves and voila, like a seasoned pro he gets it right on the first try.
“Nice try man”, I beamed. The intern smiled back and modestly waved and went “Aw no you’ll learn the trick after some getting used to and practice”. We were both clearing the trolley and heading back to the unit office when a nurse came to inform that Mr. Moody would be changed from IV medications to oral tablets.
The intern and I looked at each other and we both sighed.
*names have been obviously changed to protect patient’s privacy