Tiger Woods and the case of the vanishing veins. HUH?!? Read on to find out...
I just finished my two week anesthesiology rotation. the point of this rotation was to ensure that all aspiring pediatricians are instructed in the fine art of intubation and IV and art line placement. I embarked on this rotation with great fear and trepidation as in medical school my success rate for starting IVs was approximately 0.125. The first week, I was stationed in the pediatric OR suite with the daunting assignment of all IV starts on children under the age of 5. Amazingly, I got them ALL! My first attempt was on a 2 y/o male. After he was lulled off to sleep with the vanilla scented sleeping gas (more accurately, after he screamed and struggled and we finally got him to breath enough of the gaseous vapor to cause him to suddenly cease all violent motion and sleep) I went to work. Amazingly, I hit the first vein I attempted with great venous return. The needle threading was a little harder and required attending assistance, but I was in orbit! The rest of the day, every single child I attempted I got the vein on my FIRST attempt! It was uncanny, surreal. I even got an invisible vein on a chubby (politically correct word for fat) 1 year after the attending had attempted THREE times!!!! I kept thinking my luck would come to a cataclysmic halt...but it didn't. I think I could have closed my eyes and found the veins.
The next week, flush with feelings of grandeur and ecstasy, I decided to expand my IV experience to include those children not already asleep on the OR table. Unfortunately, the UCDMC inpatient OR caters mostly to children younger than 5 (the minimal age for pre-sleeping IV starts). So, I went in search of greener territory. One of the nurses suggested I spend a couple of days in the adult outpatient OR as adult veins are supposedly similar to older children's veins.
So, with a bag full of threading needles and a head full of hot air I headed over to the adult side. I explained to the charge nurse my errand. He eyed me suspiciously, "and HOW many IVs have you actually started?" Proudly I was able to expound upon my success story from the previous week.
"OK, he said reluctantly," why don't you try Mr. Jones. He has really good veins. Mr. Jones did have really good veins. From across the room I could see nice long straight purple ridges trailing across his hands and up his arms. This one would be easy.
Confidently, I set up my equipment, applied the tourniquet, and started probing for the veins. Ah, what nice veins. The dorsal surface of his hand had the juiciest veins. Quickly I cleaned the surface and easily inserted the needle. It glided in effortlessly... and then, of all things, the vein disappeared. Literally, I kid you not it DISAPPEARED!!!! and then, try as I might I could not get a flashback. It had been right there and then "poof" it was gone. Foiled and confused, I finally had to draw back my needle and take off the tourniquet. Inspecting the arm again, I found to my alarm that all of his veins had gone into turtle-like hiding. The charge nurse had been surreptitiously watching me and he now came to my rescue and although he couldn't see any veins, he easily slid the needle in and had it threaded before the man could even blink.
Despite being embarrassed and confused at my failure, I decided to put on a brave front and try the process again on a different patient. Once again, she had great veins. This time, after inserting the needle her veins didn't disappear. I could see them, I could feel them, but the needle wouldn't go in. They kept rolling out of the way. Despite my best effort, I couldn't get that needle to go in and finally once again had to get assistance from the charge nurse. All six attempts that day met with similar non-success. I finally slunk away to wallow in self pity and nurse my deflated ego.
The next day, I discussed with my attending what had gone wrong. This was his explanation: overconfident sloppiness. Basically, because I thought the adult veins looked so easy, I didn't really bother to plan my approach, watch my technique, and go in carefully. I just stuck the needle toward the vein, assuming it would have to enter as the vein was SO visible.
"The reason," he continued, "Tiger Woods" is the best golfer is because he takes just as much time planning his technique on the easy shots as he does on the hard shots. When he gets to the hard shots, his technique is precisely the same as he used for the easy shots. It works every time."
I thought about that a lot. I think he was right. Later that day, I went back to the adult unit. The same nurse was there. I think he was surprised to see me. This time, I wasn't overconfident, I wanted to learn. I approached every vein, no matter how easy it looked as if it was a preemie baby's vein. Amazingly, I got EVERY single IV except for one (that lady had a lot of scar tissue, the nurse missed as well).
So here's what I learned. Remember that verse in Luke 16:10 “He who is faithful in what is least is faithful also in much; and he who is unjust in what is least is unjust also in much." Well, it works not just in the spiritual realm, it is an imperative int he work world as well! Let's all be faithful.
-Rachel
I just finished my two week anesthesiology rotation. the point of this rotation was to ensure that all aspiring pediatricians are instructed in the fine art of intubation and IV and art line placement. I embarked on this rotation with great fear and trepidation as in medical school my success rate for starting IVs was approximately 0.125. The first week, I was stationed in the pediatric OR suite with the daunting assignment of all IV starts on children under the age of 5. Amazingly, I got them ALL! My first attempt was on a 2 y/o male. After he was lulled off to sleep with the vanilla scented sleeping gas (more accurately, after he screamed and struggled and we finally got him to breath enough of the gaseous vapor to cause him to suddenly cease all violent motion and sleep) I went to work. Amazingly, I hit the first vein I attempted with great venous return. The needle threading was a little harder and required attending assistance, but I was in orbit! The rest of the day, every single child I attempted I got the vein on my FIRST attempt! It was uncanny, surreal. I even got an invisible vein on a chubby (politically correct word for fat) 1 year after the attending had attempted THREE times!!!! I kept thinking my luck would come to a cataclysmic halt...but it didn't. I think I could have closed my eyes and found the veins.
The next week, flush with feelings of grandeur and ecstasy, I decided to expand my IV experience to include those children not already asleep on the OR table. Unfortunately, the UCDMC inpatient OR caters mostly to children younger than 5 (the minimal age for pre-sleeping IV starts). So, I went in search of greener territory. One of the nurses suggested I spend a couple of days in the adult outpatient OR as adult veins are supposedly similar to older children's veins.
So, with a bag full of threading needles and a head full of hot air I headed over to the adult side. I explained to the charge nurse my errand. He eyed me suspiciously, "and HOW many IVs have you actually started?" Proudly I was able to expound upon my success story from the previous week.
"OK, he said reluctantly," why don't you try Mr. Jones. He has really good veins. Mr. Jones did have really good veins. From across the room I could see nice long straight purple ridges trailing across his hands and up his arms. This one would be easy.
Confidently, I set up my equipment, applied the tourniquet, and started probing for the veins. Ah, what nice veins. The dorsal surface of his hand had the juiciest veins. Quickly I cleaned the surface and easily inserted the needle. It glided in effortlessly... and then, of all things, the vein disappeared. Literally, I kid you not it DISAPPEARED!!!! and then, try as I might I could not get a flashback. It had been right there and then "poof" it was gone. Foiled and confused, I finally had to draw back my needle and take off the tourniquet. Inspecting the arm again, I found to my alarm that all of his veins had gone into turtle-like hiding. The charge nurse had been surreptitiously watching me and he now came to my rescue and although he couldn't see any veins, he easily slid the needle in and had it threaded before the man could even blink.
Despite being embarrassed and confused at my failure, I decided to put on a brave front and try the process again on a different patient. Once again, she had great veins. This time, after inserting the needle her veins didn't disappear. I could see them, I could feel them, but the needle wouldn't go in. They kept rolling out of the way. Despite my best effort, I couldn't get that needle to go in and finally once again had to get assistance from the charge nurse. All six attempts that day met with similar non-success. I finally slunk away to wallow in self pity and nurse my deflated ego.
The next day, I discussed with my attending what had gone wrong. This was his explanation: overconfident sloppiness. Basically, because I thought the adult veins looked so easy, I didn't really bother to plan my approach, watch my technique, and go in carefully. I just stuck the needle toward the vein, assuming it would have to enter as the vein was SO visible.
"The reason," he continued, "Tiger Woods" is the best golfer is because he takes just as much time planning his technique on the easy shots as he does on the hard shots. When he gets to the hard shots, his technique is precisely the same as he used for the easy shots. It works every time."
I thought about that a lot. I think he was right. Later that day, I went back to the adult unit. The same nurse was there. I think he was surprised to see me. This time, I wasn't overconfident, I wanted to learn. I approached every vein, no matter how easy it looked as if it was a preemie baby's vein. Amazingly, I got EVERY single IV except for one (that lady had a lot of scar tissue, the nurse missed as well).
So here's what I learned. Remember that verse in Luke 16:10 “He who is faithful in what is least is faithful also in much; and he who is unjust in what is least is unjust also in much." Well, it works not just in the spiritual realm, it is an imperative int he work world as well! Let's all be faithful.
-Rachel
Comments
Can't wait to see you this weekend!!!