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TSR Med Students' Society Part V
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Original post by Helenia
Because pockets/handbags are well known to be much cleaner than necks...
I honestly don't care if students are wearing steths while on placement. You'll look a nob if you wear it to lectures or the supermarket (one friend did this by accident) but if you're actually using it I see no harm.
I honestly don't care if students are wearing steths while on placement. You'll look a nob if you wear it to lectures or the supermarket (one friend did this by accident) but if you're actually using it I see no harm.
I pointed this out to infection control. This was not well received.
Original post by Tech
This. I don't wear it around my neck because I want to look important or feel like I'm on ER. I do it because I don't have the pocket space and like to have my hands free. It's the norm here and no-one seems bothered by it.
Yah I have ohcm and miscellaneous books stuffed into my pockets... Besides the neck is such a natural place to place a steth.
Original post by Hydromancer
I pointed this out to infection control. This was not well received.
Yah I have ohcm and miscellaneous books stuffed into my pockets... Besides the neck is such a natural place to place a steth.
Yah I have ohcm and miscellaneous books stuffed into my pockets... Besides the neck is such a natural place to place a steth.
How big pockets do you have?? I can fit my phone and a pen in my pocket if I'm lucky. I'm currently on the lookout for dresses with pockets for FY1.
My stethoscope lives in my handbag* unless I'm using it. Infection control would have a field day if they got hold of it.
*which stays in the doctors office. Every time I think about taking a small bag with me in place of pockets I think of that girl on junior doctors... Just weird.
Original post by Democracy
Tried placing my first cannula today: Cannula 1 - Democracy 0
Really hope it'll get easier with more practice...I only pity the poor patients who have to put up with me until then
Really hope it'll get easier with more practice...I only pity the poor patients who have to put up with me until then
It does, i was patchy throughout 3rd and 4th year, then this year i really got it, i hit about 90% as well now, which is a huge improvement considering 2 months ago i missed 6 on the bounce in one particularly harrowing night of shadowing. As was said above, it really is just practice. Got some (hopefully not too patronising) tips though, some i picked up from juniors and some i realised myself:
Top tips:
- Really anchor the skin so the vein can't move. If it's a hand, get them to make a loose fist then pull the skin down between their knuckles. It's basically essential in old ladies with wobbly veins.
- Look for a vein junction. Often on the hand you have a point where 2 veins join in a sort of upside down Y shape. Go in with the needle at the cleft of the Y, that way you're aiming at a fairly fixed, large area and you can't really miss either side, only above or below.
- Don't go in too far, almost without fail i find the vein is a lot closer to the surface than i thought, i caused many a haematoma by going straight through it at first.
- Don't go in too steep. I was taught to go in fairly acutely then flatten out, in reality i've found going in fairly shallow (10-15 degree angle) does the trick and avoids the risk of going straight through the other side.
- If you're not sure about it, don't go for it straight away, try both arms and hands before you gamble. More than once i missed on one side then after repositioning realised there was a barnstorming vein on the other.
- Jiggle it! (probably the most important trick) Don't be scared to move around a bit if you don't get flashback straight away, you're usually close and you'll usually hit it eventually. Patients might moan but it doesn't actually hurt that much, and it's better than stabbing them a second time.
- If you're convinced you're in but aren't getting flashback, withdraw the needle a mm or 2 anyway and look for the second flashback. Sometimes it is there but you don't get the first flashback. If it isn't just pop the needle back forward again and go hunting.
- There's no shame in going for a blue cannula, they are significantly easier to get in and they usually do the trick. When you're asked to do it, check with the nurse/doctor what it's for and ask them if a blue would be suitable if you can't get a pink in. Normally it's fine (maintenance fluids for example), though not in all cases (transfusion, contrast sometimes etc), always worth checking though.
- Finally, keep trying. If you fail once, always always try a 2nd time. If you fail a 2nd time, give it another go. If you fail again it's your call. I usually try a 3rd time then give it up as a lost cause if i don't get it then. It's rare though, 2nd time usually does the trick.
(edited 10 years ago)
Original post by hoonosewot
It does, i was patchy throughout 3rd and 4th year, then this year i really got it, i hit about 90% as well now, which is a huge improvement considering 2 months ago i missed 6 on the bounce in one particularly harrowing night of shadowing. As was said above, it really is just practice. Got some (hopefully not too patronising) tips though, some i picked up from juniors and some i realised myself:
Spoiler
I like these nuggets of advice, especially the junction-hand-vein one. The vein is less likely to move or kink at confluence points.
I'd also add: organise yourself. Make sure everything is nicely placed around you so you're not ferreting for bits and pieces of kit as you go: makes you look amateurish and also gets you in a mess.
Next one applies to venepuncture more than cannulation, but it's still a nice technique. Sometimes when going for a less-than-obvious/deeper vein I've had the tourniquet on, cleansed it, got my needle et c. built up and then gone back to my spot and lost where I wanted to go. If you start palpating around again you've de-sterilised the area. A good way to 'mark' your target is to leave the alcohol wipe on the patient's arm with the corner pointing just above the spot you want to go in. Means you don't lose your target as you look away and finish putting your stuff together.
(edited 10 years ago)
Original post by Becca-Sarah
How big pockets do you have?? I can fit my phone and a pen in my pocket if I'm lucky. I'm currently on the lookout for dresses with pockets for FY1.
My stethoscope lives in my handbag* unless I'm using it. Infection control would have a field day if they got hold of it.
*which stays in the doctors office. Every time I think about taking a small bag with me in place of pockets I think of that girl on junior doctors... Just weird.
My stethoscope lives in my handbag* unless I'm using it. Infection control would have a field day if they got hold of it.
*which stays in the doctors office. Every time I think about taking a small bag with me in place of pockets I think of that girl on junior doctors... Just weird.
Um... Wallet, pen, phone, ohcm, notebook, a 'topical' book (pocket ecg etc), my mini clinical examinations book and of course some tissue just in case. It requires a lot of space management (takes me five minutes to arrange everything) and torn pocket repairs.
Handbags etc are a no no in the teaching hospital I am mostly based in.
To add to the great cannula/venepuncture tips above:
What you can feel is more important than what you can see.
The little veins on the underside of the wrist are great with a butterfly.
Don't put it over a joint, it's uncomfortable and there's a risk of cannula emboli.
Put an incopad/paper towels under the arm/hand. The one time you think you don't need to, they will bleed everywhere.
Ask the nurses if you need to fill out a cannula 'bundle' / monitoring sheet / other pointless piece of paperwork for the nurses to audit. You get brownie points for asking (ditto for asking where cleaning stuff is if you make a mess / to clean the equipment tray).
What you can feel is more important than what you can see.
The little veins on the underside of the wrist are great with a butterfly.
Don't put it over a joint, it's uncomfortable and there's a risk of cannula emboli.
Put an incopad/paper towels under the arm/hand. The one time you think you don't need to, they will bleed everywhere.
Ask the nurses if you need to fill out a cannula 'bundle' / monitoring sheet / other pointless piece of paperwork for the nurses to audit. You get brownie points for asking (ditto for asking where cleaning stuff is if you make a mess / to clean the equipment tray).
Original post by Becca-Sarah
How big pockets do you have?? I can fit my phone and a pen in my pocket if I'm lucky. I'm currently on the lookout for dresses with pockets for FY1.
My stethoscope lives in my handbag* unless I'm using it. Infection control would have a field day if they got hold of it.
*which stays in the doctors office. Every time I think about taking a small bag with me in place of pockets I think of that girl on junior doctors... Just weird.
My stethoscope lives in my handbag* unless I'm using it. Infection control would have a field day if they got hold of it.
*which stays in the doctors office. Every time I think about taking a small bag with me in place of pockets I think of that girl on junior doctors... Just weird.
Regarding the bit in bold, same here! (although not for FY1
). Let me know if you find something good though. 
Also, I don't think we're allowed to carry small bags either.
Thanks everyone for the tips as well, although I'm feeling a bit apprehensive about beginning placements in May, I'm mainly looking forward to them now.. as long as I pass my exams first.
(edited 10 years ago)
Original post by Angury
Regarding the bit in bold, same here! (although not for FY1 ). Let me know if you find something good though.
Also, I don't think we're allowed to carry small bags either.
Thanks everyone for the tips as well, although I'm feeling a bit apprehensive about beginning placements in May, I'm mainly looking forward to them now.. as long as I pass my exams first.
). Let me know if you find something good though. Also, I don't think we're allowed to carry small bags either.
Thanks everyone for the tips as well, although I'm feeling a bit apprehensive about beginning placements in May, I'm mainly looking forward to them now.. as long as I pass my exams first.
So far, nothing decent. This hasn't stopped me buying stuff anyway - got a lovely stripy dress the other day with perfectly just-above-elbow sleeves. Mango are good for skirts with pockets (albeit not OHCM-size ones).
Original post by Tech
This. I don't wear it around my neck because I want to look important or feel like I'm on ER. I do it because I don't have the pocket space and like to have my hands free. It's the norm here and no-one seems bothered by it.
Used to keep mine in my back pocket until I sat on it and bent the earpieces in some ungodly way. Never again. Just about managed to bend them back (I should have been a metalworker), but still feels really weird in my ears... pulling in all sorts of ways. Moral of the story is... who cares if you have it round your neck on the ward, it's not worth ****ing up a steth by going out of your way to avoid looking like a real doctor. Either neck or hold it (wrap it around the logbook)!
Original post by Kinkerz
A good way to 'mark' your target is to leave the alcohol wipe on the patient's arm with the corner pointing just above the spot you want to go in. Means you don't lose your target as you look away and finish putting your stuff together.
prsom! alcohol wipe is a good one would deffo try it out!
Whilst we're on the cannula tips and tricks lark, some stuff I was taught:
Once you get the first flashback, lift the whole cannula up slightly, opens up the vein you've just squished by putting a needle into it, before advancing a few mms before going for second flashback.
When you're putting the cannula in, hang the arm over the side of the bed a little for a bit of a gravity bonus, then, to reduce any bleeding all over the place - before you take the needle right out and take off the tourniquet, rest the arm across the patient.
Also, if you get a bit of a shaky hand (like I do sometimes, especially when I just started), rest your little finger on the patients arm/hand before going for it.
Works for me anyway!
Posted from TSR Mobile
Once you get the first flashback, lift the whole cannula up slightly, opens up the vein you've just squished by putting a needle into it, before advancing a few mms before going for second flashback.
When you're putting the cannula in, hang the arm over the side of the bed a little for a bit of a gravity bonus, then, to reduce any bleeding all over the place - before you take the needle right out and take off the tourniquet, rest the arm across the patient.
Also, if you get a bit of a shaky hand (like I do sometimes, especially when I just started), rest your little finger on the patients arm/hand before going for it.
Works for me anyway!
Posted from TSR Mobile
Original post by Becca-Sarah
How big pockets do you have?? I can fit my phone and a pen in my pocket if I'm lucky. I'm currently on the lookout for dresses with pockets for FY1.
I've been collecting these since 3rd year
Why aren't they mandatory?!Original post by hoonosewot
Top tips:
Top tips:
Sadly I can't like this
Original post by Beska
Used to keep mine in my back pocket until I sat on it and bent the earpieces in some ungodly way. Never again. Just about managed to bend them back (I should have been a metalworker), but still feels really weird in my ears... pulling in all sorts of ways. Moral of the story is... who cares if you have it round your neck on the ward, it's not worth ****ing up a steth by going out of your way to avoid looking like a real doctor. Either neck or hold it (wrap it around the logbook)!
Good luck trying to do that with the 5th year ones! For some stupid reason they've decided A4 is a fab size
Original post by Mushi_master
Whilst we're on the cannula tips and tricks lark, some stuff I was taught:
Once you get the first flashback, lift the whole cannula up slightly, opens up the vein you've just squished by putting a needle into it, before advancing a few mms before going for second flashback.
When you're putting the cannula in, hang the arm over the side of the bed a little for a bit of a gravity bonus, then, to reduce any bleeding all over the place - before you take the needle right out and take off the tourniquet, rest the arm across the patient.
Also, if you get a bit of a shaky hand (like I do sometimes, especially when I just started), rest your little finger on the patients arm/hand before going for it.
Works for me anyway!
Posted from TSR Mobile
Once you get the first flashback, lift the whole cannula up slightly, opens up the vein you've just squished by putting a needle into it, before advancing a few mms before going for second flashback.
When you're putting the cannula in, hang the arm over the side of the bed a little for a bit of a gravity bonus, then, to reduce any bleeding all over the place - before you take the needle right out and take off the tourniquet, rest the arm across the patient.
Also, if you get a bit of a shaky hand (like I do sometimes, especially when I just started), rest your little finger on the patients arm/hand before going for it.
Works for me anyway!
Posted from TSR Mobile
That's actually quite legendary advice, cheers mate!
One more cannula tip that I found particularly useful when I was consistently managing to get blood all over the bed while faffing about with the stopper... Rather than just applying pressure over the end of the cannula, apply the pressure and pull slightly towards you (not sure I've described it very well, it's easier to observe) - much cleaner with them using that technique!
Original post by hoonosewot
- There's no shame in going for a blue cannula, they are significantly easier to get in and they usually do the trick. When you're asked to do it, check with the nurse/doctor what it's for and ask them if a blue would be suitable if you can't get a pink in. Normally it's fine (maintenance fluids for example), though not in all cases (transfusion, contrast sometimes etc), always worth checking though.
- There's no shame in going for a blue cannula, they are significantly easier to get in and they usually do the trick. When you're asked to do it, check with the nurse/doctor what it's for and ask them if a blue would be suitable if you can't get a pink in. Normally it's fine (maintenance fluids for example), though not in all cases (transfusion, contrast sometimes etc), always worth checking though.
This is true. Do bear in mind, however, that if you send a patient with an ectopic to theatre with blues in their ACFs, I will hunt you down and murder you. Especially if you haven't taken the 2nd G&S sample. *oncallrage*
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Original post by crazylemon
Has this actually happened to you?
More times than I care to remember. I haven't actually done any murdering yet though.
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(edited 10 years ago)
Original post by Helenia
More times than I care to remember. I haven't actually done any murdering yet though.
Posted from TSR Mobile
Posted from TSR Mobile
But when you perfect that blowdart gun that fires 14G venflons...
Right, so I was being a complete nerd and writing up a voluntary reflection after our comm skills session this morning. Yeah, I know. Not cool. Our session was on "Difficult Conversations about Women's Health"
Anyway, just thought I would ask on here - how do males feel about asking young females questions about really sensitive issues about monthly cycles, regularity or lack of, painful menses, IMB, PCB, dyspareunia etc.? Now, don't get me wrong, I'm pretty comfortable talking about this sort of stuff (and indeed my sexual histories have been described as "rather thorough"
), and I'm fine taking this sort of history from pre/post menopausal female adults (20's+), but today, I had to take a hx from an actor playing a 15yr old girl who had come in (mum was waiting in the waiting room) with painful, heavy, but regular periods (LMP was 10 days ago), in a fully consensual sexual relationship with a guy from school (think he was 16/17) who she regularly had unprotected sex with, missing school because of severe period pains, stressed about upcoming GCSEs, mum wasn't aware about the sexual nature of her relationship with her bf, and on top of all of this, had what sounded like vulvovaginal candidiasis... Yeah. Easy. You can see why I decided to reflect on it! 
Now, I just about got through that consultation and decided on a haphazard management plan (there was just so much to cover in a 10 min consultation), but It was really strange. I got rather paternalistic and phrased things much like an awkward dad would if he had to have "the talk" with his daughter. I actually realised this earlier on in the consultation, but I couldn't think of how else to phrase things so just carried on. This was reflected in the feedback I received from the actor who thought I was "overly professional".
I guess what I'm asking is, clearly, we should all be prepared for apparently "common" situations like this by the end of medical school, but how do others (particularly males - females seem to be slightly more comfortable with these conversations from what I have witnessed, though I could be VERY, VERY wrong) feel about taking sexual/obstetric/gynecological histories from young teenage females (as above) who are more often than not, sexually active? I struggled this morning. A lot. But hey, that's what these sessions are for right?
Anyway, just thought I would ask on here - how do males feel about asking young females questions about really sensitive issues about monthly cycles, regularity or lack of, painful menses, IMB, PCB, dyspareunia etc.? Now, don't get me wrong, I'm pretty comfortable talking about this sort of stuff (and indeed my sexual histories have been described as "rather thorough"
), and I'm fine taking this sort of history from pre/post menopausal female adults (20's+), but today, I had to take a hx from an actor playing a 15yr old girl who had come in (mum was waiting in the waiting room) with painful, heavy, but regular periods (LMP was 10 days ago), in a fully consensual sexual relationship with a guy from school (think he was 16/17) who she regularly had unprotected sex with, missing school because of severe period pains, stressed about upcoming GCSEs, mum wasn't aware about the sexual nature of her relationship with her bf, and on top of all of this, had what sounded like vulvovaginal candidiasis... Yeah. Easy. You can see why I decided to reflect on it! Now, I just about got through that consultation and decided on a haphazard management plan (there was just so much to cover in a 10 min consultation), but It was really strange. I got rather paternalistic and phrased things much like an awkward dad would if he had to have "the talk" with his daughter. I actually realised this earlier on in the consultation, but I couldn't think of how else to phrase things so just carried on. This was reflected in the feedback I received from the actor who thought I was "overly professional".
I guess what I'm asking is, clearly, we should all be prepared for apparently "common" situations like this by the end of medical school, but how do others (particularly males - females seem to be slightly more comfortable with these conversations from what I have witnessed, though I could be VERY, VERY wrong) feel about taking sexual/obstetric/gynecological histories from young teenage females (as above) who are more often than not, sexually active? I struggled this morning. A lot. But hey, that's what these sessions are for right?
Original post by Medicine Man
I guess what I'm asking is, clearly, we should all be prepared for apparently "common" situations like this by the end of medical school, but how do others (particularly males - females seem to be slightly more comfortable with these conversations from what I have witnessed, though I could be VERY, VERY wrong) feel about taking sexual/obstetric/gynecological histories from young teenage females (as above) who are more often than not, sexually active? I struggled this morning. A lot. But hey, that's what these sessions are for right?
It's not exclusive to being male. I've been a teenage girl and still struggle with those conversations. On paeds day case ward I had to ask all the female patients if they were sexually active and it was the most awkward thing ever. They either look horrified that you even ask or are wayyyy more chilled about it than they should be at 14.
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