protectedmode
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First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.
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Helenia
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(Original post by protectedmode)
First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.
I don't think anyone's going to be calling the GMC on you just yet!

People get bruises occasionally, it's just one of those things. Happens even more with cannulas than phlebotomy. Sounds like you did pretty much what anyone would - tourniquet off, pressure on. Don't beat yourself up!

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shiggydiggy
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I hope you got MDU cover, son.

But srs though, don't worry about it. It happens.
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selenag123
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(Original post by Helenia)
I don't think anyone's going to be calling the GMC on you just yet!

People get bruises occasionally, it's just one of those things. Happens even more with cannulas than phlebotomy. Sounds like you did pretty much what anyone would - tourniquet off, pressure on. Don't beat yourself up!

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Are these patients usually on anticoagulants?
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Helenia
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(Original post by selenag123)
Are these patients usually on anticoagulants?
Which patients? Most inpatients are on daily LMWH but that shouldn't really make a big difference to this sort of thing. Warfarin does make people a bit more likely to bruise, but mostly it's just technique and the quality of the vein.

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kpwxx
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(Original post by protectedmode)
First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.
As a patient I have had my blood taken quite a lot of times by various different people and the majority of doctors who have done it have made some sort of mess... one spilt my blood all down my arm. I never cared, I just thought they are probably less practised in taking blood. Oh well. I'm almost certain the patient won't have cared; now you know more about what to do next time

xxx
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selenag123
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(Original post by Helenia)
Which patients? Most inpatients are on daily LMWH but that shouldn't really make a big difference to this sort of thing. Warfarin does make people a bit more likely to bruise, but mostly it's just technique and the quality of the vein.

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I remember when I was on a ward round in my third year and the patient had significant bruising in both anterior cubital fossa regions. The consultant explained that the patients blood was taken but that she was also on warfarin. Are there any other medications that can lead to easily brusing? Steroids???
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Helenia
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(Original post by selenag123)
I remember when I was on a ward round in my third year and the patient had significant bruising in both anterior cubital fossa regions. The consultant explained that the patients blood was taken but that she was also on warfarin. Are there any other medications that can lead to easily brusing? Steroids???
Steroids thin the skin so make the patient bruise easily in response to minor trauma that wouldn't bruise a normal person, but they are not anticoagulants so wouldn't increase bruising from invasive procedures. The majority of patients are not on warfarin. Bruising when you stick needles into blood vessels is just something that happens sometimes. You should see the mess I made overnight putting in a Vascath + central line!
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selenag123
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(Original post by Helenia)
Steroids thin the skin so make the patient bruise easily in response to minor trauma that wouldn't bruise a normal person, but they are not anticoagulants so wouldn't increase bruising from invasive procedures. The majority of patients are not on warfarin. Bruising when you stick needles into blood vessels is just something that happens sometimes. You should see the mess I made overnight putting in a Vascath + central line!
Just for future reference (and relating to this thread) if you think you made a mess when doing a procedure do you inform anyone or write it in the notes? This sounds like an SJT question but I just wanted to know what you would do in reality.

Thanks
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dances_with_lamposts
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(Original post by selenag123)
Just for future reference (and relating to this thread) if you think you made a mess when doing a procedure do you inform anyone or write it in the notes? This sounds like an SJT question but I just wanted to know what you would do in reality.

Thanks
If I've made a mess, I usually tell (& apologise to) the nurse looking after the patient so that they know and don't get mad at me, but I don't write it in the notes.


(Original post by protectedmode)
First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.
OP, don't worry about it. It won't be the last time you give a patient a big bruise. You will get better with practice but sometimes it happens anyway.
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moonkatt
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(Original post by dances_with_lamposts)
If I've made a mess, I usually tell (& apologise to) the nurse looking after the patient so that they know and don't get mad at me, but I don't write it in the notes.
This is why we usually insist you put a pad under the patient before doing any invasive line insertion so that it's not a major issue

It's a messy procedure though, so it's to be expected, I've never seen any of the doctors document that it was messy though. Just the usual, used ultrasound, GGHM, technique used and what length the lines were secured at and all that jazz.

If you want bonus points though, offer to help roll the patient to get rid of any messy sheets :P
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dances_with_lamposts
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(Original post by moonkatt)
This is why we usually insist you put a pad under the patient before doing any invasive line insertion so that it's not a major issue

It's a messy procedure though, so it's to be expected, I've never seen any of the doctors document that it was messy though. Just the usual, used ultrasound, GGHM, technique used and what length the lines were secured at and all that jazz.

If you want bonus points though, offer to help roll the patient to get rid of any messy sheets :P
Oh yeah, inco pads are a given for things like art lines (or catheters). But sometimes you make a mess doing something simple like a venflon. I usually always help to clean up (depending on how much mess I made) unless I'm in call with a million other jobs to do.

What's GGHM?

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moonkatt
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(Original post by dances_with_lamposts)
Oh yeah, inco pads are a given for things like art lines (or catheters). But sometimes you make a mess doing something simple like a venflon. I usually always help to clean up (depending on how much mess I made) unless I'm in call with a million other jobs to do.

What's GGHM?

When they use leadercaths rather than a flowswitch for an A-line it usually gets a tad messy.

GGHM: gloves/gown/hat/mask
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zed963
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Bruising may occurs generally nothing to worry about. Removing tourniquet and applying pressure is sensible as well as applying a cloth thing to collect excess blood when pressure is applied.

The bruising is worse in octopus cannulas and IV flush.

sometimes heparin can make the bruise look worse.
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iJess
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I'm not a medical student but I've had blood taken from a medical student and it was awful. She pulled the needle out whilst doing it and somehow blood squirted all over my jeans and that arm really did bruise, she then tried the other arm but my blood wasn't coming out of it for some reason, I had 2 sore arms instead of one haha. I don't mind my blood being taken though, I like watching it being done
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Helenia
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(Original post by selenag123)
Just for future reference (and relating to this thread) if you think you made a mess when doing a procedure do you inform anyone or write it in the notes? This sounds like an SJT question but I just wanted to know what you would do in reality.

Thanks
Define making a mess...

If I gave a patient a bruise taking their blood or putting in a cannula, no I wouldn't tell anyone. I'd apologise to the patient, but don't see any need to tell their nurse or anything as it won't affect what they are doing.

If I'm putting in an art line/CVC then I always use an inco sheet but if a bit of blood gets around the side I will tell the nurse (and apologise to them, because they'll have to change the sheets!) If I'm not busy I'll stay around to help change the bed.
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arterialspray
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(Original post by protectedmode)
First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.
One of my first few times taking blood, I completely forgot to release the tourniquet. Did the pressure, taping gauze, all while the tourniquet was still on... Happily handed over the samples and went home. On the way home, realised in a panic that I had left the tourniquet on the patient, and ran back to the ward. Patient informed me that he had taken the tourniquet off himself. He also had a massive bruise. Embarrassing!


Wasn't the last time I left a tourniquet on a patient either.. did it at least twice more.after that.
Not to mention the time when my hand was shaking so much that I punctured the vein every which way and caused a bruise covering the entire dorsum of the poor patient's hand. Don't think I ended up getting any blood either.


I was pretty traumatised by these attempts and refused to do any bloods/cannulas for a year or so.


What you're describing sounds okay for a first attempt. I doubt you were any worse than me on my 5th attempt!
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protectedmode
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Thanks everyone. I will try to take it as a learning experience - it was just down to my poor technique rather than anything else, there shouldn't have been anything difficult about it, which is why I felt particularly bad - the patient didn't deserve to have such a mess made and it was just pot luck that they ended up with me! It was their first time having bloods taken too and they even said what a good job I did. Wouldn't have been saying that a few hours later...

I find it quite hard to stabilise the needle while putting vacutainers on/off - that is how I think I went through the vein in the first place. Any tips or is it just practice?
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shiggydiggy
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(Original post by protectedmode)
I find it quite hard to stabilise the needle while putting vacutainers on/off - that is how I think I went through the vein in the first place. Any tips or is it just practice?
This is true in all fairness. If you're gonna mess up doing bloods, it's probably during this part because the needle can fly all over the shop when you're trying to remove the vacutainer.

I hold the plastic vacutainer needle cover with one hand, making sure to rest my hand against the patient and use the other to remove the bottle. Make sure you apply counter traction with the cover (i.e. with your free hand holding the bottle, push the vacutainer cover away with your index and thumb right at the top of the bottle while overall pulling the bottle, if that makes sense).

Also removing the bottle with a twisting back and forth motion helps it come off with less of a sudden jerk.

But yeah stabilising against the patient is most helpful.
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protectedmode
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(Original post by shiggydiggy)
This is true in all fairness. If you're gonna mess up doing bloods, it's probably during this part because the needle can fly all over the shop when you're trying to remove the vacutainer.

I hold the plastic vacutainer needle cover with one hand, making sure to rest my hand against the patient and use the other to remove the bottle. Make sure you apply counter traction with the cover (i.e. with your free hand holding the bottle, push the vacutainer cover away with your index and thumb right at the top of the bottle while overall pulling the bottle, if that makes sense).

Also removing the bottle with a twisting back and forth motion helps it come off with less of a sudden jerk.

But yeah stabilising against the patient is most helpful.
Thank you - some things to try next time. Prior to this, aside from on mannekins, I had only taken blood with butterfly needles (even though some people say you shouldn't - more expensive perhaps) where the vacutainer movements aren't directly connected to the needle if that makes sense. So stabilising my hand seems to be the way to go.
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