brightcitylights
Badges: 10
Rep:
?
#1
Report Thread starter 6 years ago
#1
How can I prepare for it? Esp worried about practical procedures cause I sometimes struggle with taking blood and cannulating and my first job is surgery! Any tips??
0
reply
hoonosewot
Badges: 11
Rep:
?
#2
Report 6 years ago
#2
You've been on placement in hospital all year right? You should have been doing tons of bloods and cannulas, if you're not confident yet i'd advise you make sure you get some more done before you start. Everyone struggles sometimes, that's totally normal, but you should really be capable of doing it 9 times out 10 by the time you start. Same for ABGs and catheters.
0
reply
Helenia
Badges: 20
Rep:
?
#3
Report 6 years ago
#3
If you weren't nervous I'd be more surprised. Just keep practising with the procedures, it honestly will get better. I thought I was alright at cannulating before starting anaesthetics, but the extra practice has improved my hit rate even further.

This doesn't mean I will be happy if you call me at 3am with a difficult one though...
1
reply
brightcitylights
Badges: 10
Rep:
?
#4
Report Thread starter 6 years ago
#4
(Original post by hoonosewot)
You've been on placement in hospital all year right? You should have been doing tons of bloods and cannulas, if you're not confident yet i'd advise you make sure you get some more done before you start. Everyone struggles sometimes, that's totally normal, but you should really be capable of doing it 9 times out 10 by the time you start. Same for ABGs and catheters.
I've actually done hardly any this year since my placements have been more specialist but I will try to get some prac before august.
0
reply
fishfacesimpson
Badges: 9
Rep:
?
#5
Report 6 years ago
#5
It's perfectly normal to be nervous. You're meant to be nervous. It's good to be nervous because when things go right (as they will the majority of the time) and as you get through it you'll get a satisfaction higher than any part of your medical degree.

As for practical procedures all I can say is practise as much as you can before you start. Do a week or two of shadowing and do as many of the venflons etc. as you can.

Truthfully I'd never put a catheter in before starting F1 (except on models) and had to wake my SpR up at 4am to help me on my first night shift. I wasn't very good at cannulation but if you know the technique you'll get better very quickly. My hit rate certainly wasn't 9/10 before I started, no where near. If you find you are struggling tell your seniors and nurses who are capable on the ward to help you. By that I mean teaching you and giving you tips - NOT taking the piss and asking them to do all of your difficult venflons!
3
reply
brightcitylights
Badges: 10
Rep:
?
#6
Report Thread starter 6 years ago
#6
(Original post by fishfacesimpson)
It's perfectly normal to be nervous. You're meant to be nervous. It's good to be nervous because when things go right (as they will the majority of the time) and as you get through it you'll get a satisfaction higher than any part of your medical degree.

As for practical procedures all I can say is practise as much as you can before you start. Do a week or two of shadowing and do as many of the venflons etc. as you can.

Truthfully I'd never put a catheter in before starting F1 (except on models) and had to wake my SpR up at 4am to help me on my first night shift. I wasn't very good at cannulation but if you know the technique you'll get better very quickly. My hit rate certainly wasn't 9/10 before I started, no where near. If you find you are struggling tell your seniors and nurses who are capable on the ward to help you. By that I mean teaching you and giving you tips - NOT taking the piss and asking them to do all of your difficult venflons!
I've never put in a catheter either or done an abg. Will have to start practising.
1
reply
Helenia
Badges: 20
Rep:
?
#7
Report 6 years ago
#7
(Original post by brightcitylights)
I've never put in a catheter either or done an abg. Will have to start practising.
If you're unsure about ABGs, use some local anaesthetic. Only a tiny bit, and rub it in well, so the bleb doesn't get in your way. Makes a huge difference to patients.
1
reply
Da CorrupteD KiD
Badges: 9
Rep:
?
#8
Report 6 years ago
#8
As mentioned by others:

Shadow anaesthetists in day case units for cannulas (be honest with them that you want to practise cannulas and maybe airway stuff only thus allowing you to move between different anaesthetists to get all the cannulas rather than getting stuck in the theatre)

ABGS - medical or surgical admissions unit (COPD, Pancreatitis...) or leave your bleep number with the on take FY1

Catheters - hit and miss. Best thing to do in my experience is to let all the nurses know and leave them with your bleep number. Catheters are often carried out by nurses not doctors during day time. While you're there might as well ask them to bleep you for NG tubes too. Always a good practise. Alternatively find out when there's an obs and gynae or major surgery list, most patients will need a catheter. This tends to be done in anaesthetic room so you'll hit two birds with one stone by doing the cannula too!
3
reply
visesh
Badges: 17
Rep:
?
#9
Report 6 years ago
#9
(Original post by Helenia)

This doesn't mean I will be happy if you call me at 3am with a difficult one though...
I had an odd experience last week. My old team (as in April) had a 'tough cannula' for a sick patient who needed resuscitation prior to theatre. My current boss (HDU) asked me to 'go sort it out and shove some fluids in'.

Felt like a ****ing hero getting that grey in.
0
reply
nexttime
Badges: 22
Rep:
?
#10
Report 6 years ago
#10
(Original post by Helenia)
If you're unsure about ABGs, use some local anaesthetic. Only a tiny bit, and rub it in well, so the bleb doesn't get in your way. Makes a huge difference to patients.
Applicable even if you're not unsure?

Every med student i know who has had an ABG swears that they will never do one without local again!
0
reply
345rty
Badges: 12
Rep:
?
#11
Report 6 years ago
#11
I would always use local for ABGs if nobody is looking, people do seem to get shouted at for using it though.

That said they are so bloody awkward I've attempted two to date, and got neither.

Cannulas are fine, I've put two catheters in (both male) and they seem to be fine. In the hospitals I've been in they are never a doctor job so hopefully it won't be something I have to do in my next place. Likewise for cannulas, the last few firms I've been on they have all been done by the nurses or a doctors assistant.
0
reply
Becca-Sarah
Badges: 19
Rep:
?
#12
Report 6 years ago
#12
(Original post by Helenia)
If you're unsure about ABGs, use some local anaesthetic. Only a tiny bit, and rub it in well, so the bleb doesn't get in your way. Makes a huge difference to patients.
I'd be more unsure about how to use LA! Do you have to prescribe it beforehand? How much do you draw up/what strength? This is something we've never been taught (and I've never seen it done either).
2
reply
Da CorrupteD KiD
Badges: 9
Rep:
?
#13
Report 6 years ago
#13
I may be really thick for asking this. Does LA make any difference at all in terms of the pain level patients experience from an ABG compared to say, having blood taken or getting a cannula? Surely it's the penetration of the skin that's painful so in theory it should hurt just as much as the other procedures? (unless one hits the nerve in which case the LA may not work since it's so superficial anyway)I don't have years of experience under my belt compared to some of you but I have done 5-6 ABGs this year and none of the patients complained of pain, the most I got was a subtle wince, nothing more than what one would get when they take blood. I have always used an orange needle though.
0
reply
nexttime
Badges: 22
Rep:
?
#14
Report 6 years ago
#14
(Original post by 345rty)
I would always use local for ABGs if nobody is looking, people do seem to get shouted at for using it though.
What!? Why?

Because patients aren't suffering enough already? Because we like it when asthmatics get to the situation where they don't come to A&E with an acute attack because they're scared of the ABG?

Anyway - capillary blood gases. Nothing else need be said.

I've put two catheters in (both male) and they seem to be fine. In the hospitals I've been in they are never a doctor job so hopefully it won't be something I have to do in my next place.
That's the problem though - they'll come to you when its difficult and expect you to be able to sort it out when you've never done one before! A bit like the phlebotomists having one go then giving up and leaving it for the inexperienced FY1. Its stupid.

(Original post by Da CorrupteD KiD)
I may be really thick for asking this. Does LA make any difference at all in terms of the pain level patients experience from an ABG compared to say, having blood taken or getting a cannula? Surely it's the penetration of the skin that's painful so in theory it should hurt just as much as the other procedures? (unless one hits the nerve in which case the LA may not work since it's so superficial anyway)I don't have years of experience under my belt compared to some of you but I have done 5-6 ABGs this year and none of the patients complained of pain, the most I got was a subtle wince, nothing more than what one would get when they take blood. I have always used an orange needle though.
I think its that the area you're going for it more sensitive.

Regardless - a few of my colleagues have volunteered for having ABGs done on them. They all say its much, much worse than venepuncture.

Were the people you did it on old? Old people are just tough as nails. Or have relative neuropathy. Same difference.
0
reply
Da CorrupteD KiD
Badges: 9
Rep:
?
#15
Report 6 years ago
#15
(Original post by nexttime)


I think its that the area you're going for it more sensitive.

Regardless - a few of my colleagues have volunteered for having ABGs done on them. They all say its much, much worse than venepuncture.

Were the people you did it on old? Old people are just tough as nails. Or have relative neuropathy. Same difference.
No, they weren't elderly but they were definitely unwell enough to warrant an ABG to be performed. I guess the area where it's done could be more sensitive as you said but I'm not sure if I'm convinced that LA is required. But I guess everyone has their preferences, I once saw an anaesthetist using LA prior to putting a grey cannula in a housman's vein, as in the cephalic vein not an FY1's.
0
reply
nexttime
Badges: 22
Rep:
?
#16
Report 6 years ago
#16
(Original post by Da CorrupteD KiD)
No, they weren't elderly but they were definitely unwell enough to warrant an ABG to be performed. I guess the area where it's done could be more sensitive as you said but I'm not sure if I'm convinced that LA is required. But I guess everyone has their preferences, I once saw an anaesthetist using LA prior to putting a grey cannula in a housman's vein, as in the cephalic vein not an FY1's.
Have one yourself if its not too bad then get back to us.
0
reply
Da CorrupteD KiD
Badges: 9
Rep:
?
#17
Report 6 years ago
#17
(Original post by nexttime)
Have one yourself if its not too bad then get back to us.
LAs are not without risk and it stings bad too.
0
reply
belis
Badges: 17
Rep:
?
#18
Report 6 years ago
#18
Personally I find the burning from the local to be just as bad as the pain from ABG stab. Providing that they get it right away and don't have to fish around for half an hour scraping the bone in the process. I had plenty of ABGs and I don't think local made that much of a difference to the experience when I had it.
0
reply
nexttime
Badges: 22
Rep:
?
#19
Report 6 years ago
#19
(Original post by Da CorrupteD KiD)
LAs are not without risk and it stings bad too.
Not as bad as an ABG - check the literature. ABG with LA is less painful than venepuncture, in fact (which is in turn less painful than ABG re: prior discussion).

Again, if you honestly think its not so bad i suggest having one. I'm sure one of your colleagues would appreciate the practice.
0
reply
Helenia
Badges: 20
Rep:
?
#20
Report 6 years ago
#20
(Original post by Becca-Sarah)
I'd be more unsure about how to use LA! Do you have to prescribe it beforehand? How much do you draw up/what strength? This is something we've never been taught (and I've never seen it done either).
Do you really never learn how to do LA infiltration?! It's hardly rocket science!

Lidocaine 1%, you don't need more than 1ml, probably less. Absolutely zero risk of toxicity from that kind of amount unless your patient weighs less than 4kg (safe dose = 3mg/kg). I use an orange needle, raise a tiny bleb under the skin then go a little deeper - always aspirate before injecting to make sure you're not in a vessel - then rub the area firmly with a bit of gauze for about 30 sec-1 minute before doing the ABG.

(Original post by nexttime)
Applicable even if you're not unsure?

Every med student i know who has had an ABG swears that they will never do one without local again!
I always use it unless the patient is asleep or so sick they won't notice. Especially for repeated ones on asthmatics (who probably need far fewer gases than we do, if people followed BTS guidelines!) and COPD-ers. Same for any 16/14G cannulas.

These things do make a difference to patients. Yes, LA stings, but a hesitant, semi-competent ABG, especially on someone who's had loads before and has scarred-up wrists, hurts like hell. It's a much more sensitive area than most places we take blood from/cannulate. And asthmatics do avoid coming to hospital because they don't want to have gases. It's not hard, and it is kind.
0
reply
X

Quick Reply

Attached files
Write a reply...
Reply
new posts
Back
to top
Latest
My Feed

See more of what you like on
The Student Room

You can personalise what you see on TSR. Tell us a little about yourself to get started.

Personalise

Have you experienced financial difficulties as a student due to Covid-19?

Yes, I have really struggled financially (41)
18.39%
I have experienced some financial difficulties (63)
28.25%
I haven't experienced any financial difficulties and things have stayed the same (85)
38.12%
I have had better financial opportunities as a result of the pandemic (29)
13%
I've had another experience (let us know in the thread!) (5)
2.24%

Watched Threads

View All