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During my third year placement, a patient let me cannulate her as many times as it took for me to succeed. It was lucky that she was chatty. It was also lucky that she wasn’t looking at what I was doing because she bled. A lot.
A cannula is probably the most familiar part about being a patient. It’s the first bit of equipment that goes in and usually the last bit to come out. It’s how the dehydrated are given fluids, the anaemic given blood and the septic, given antibiotics. It’s also how doctors, especially junior ones, give themselves anxiety.
My hands only stopped shaking whilst inserting a cannula about 7 months ago. I think my brain gave up on being nervous because frankly, what could be worse than missing the vein, getting blood all over my dress, over the patient’s trousers and the pillow as well?
Yes. That was me. Now mind you, it’s not like I haven’t had success stories. I have. They just happen to be less interesting and somehow get overshadowed by the epic flops some attempts have been.
I think the best line a patient ever said to me was actually on my last on-call shift. I had to put in a cannula in the hand. And as I was leaving, discreetly cleaning up, the patient shouts : “So when’s the doctor coming in? You know,” he carries on, pointing to his arm which has recently been punctured and now has a bloody but working cannula in it. “To clean up the big wound you’ve just made!”
The very next day, I was part of a crash call. Somehow, I found myself inserting a cannula into this patient whose blood pressure was dropping faster than it took me to write this sentence. And what he needed was fluids. Through the very cannula I was trying to insert. Yeah, no pressure, there, doc. But in it went, up went the fluids and I’m pretty sure the reason he was eating lunch an hour later is because I managed to get that cannula in. I mean, if I couldn’t, someone else would have but I pretended I was a hero because it made me feel good about myself. (note: very few days do you feel that a single action you have done has made a huge impact so I take them as they come)
So, I guess, the point I’m trying to make is what I’ve always said: Nothing is scarier than failure but failing to try is the biggest failure of all. Also sometimes you gotta reason with yourself: what’s scarier? You having to put the cannula in or you being the patient who is so sick that needs the cannula in the first place!
It’s all about perspective :)
P.s - Don't mind me staring at you. I'm not actually looking at you, I'm just contemplating what size cannula I could get into one your veins...
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Dr Deeban Ratneswaran
You could do a whole other story on ABGs. I pretty much use USS as often as possible for ABGS - straight in, and reduces pain significantly!
Kevin - AWS
It's very true, and there is nothing better than being the one that gets that difficult canulla 😊