Have anxiety over doing a canal , ABG etc Watch

Anonymous #1
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I had a Bsc, then a year where we didn't get a chance to do anything because of nature of specialties (peads, psychiatry), so most of us haven't done these in years.

I just fear the part where you have to press the vein after opening the lid to stop blood gushing all over the patient.

Any advice?
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ecolier
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(Original post by Anonymous)
I had a Bsc, then a year where we didn't get a chance to do anything because of nature of specialties (peads, psychiatry), so most of us haven't done these in years.

I just fear the part where you have to press the vein after opening the lid to stop blood gushing all over the patient.

Any advice?
It will come with practice and experience.

Are you at med school or starting FY1? If you're at med school there'll be plenty of opportunities to practice on dummies; if you're starting FY1 then make the most of the shadowing weeks to practise under the watchful eye of the outgoing FY1!
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Democracy
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(Original post by Anonymous)
I had a Bsc, then a year where we didn't get a chance to do anything because of nature of specialties (peads, psychiatry), so most of us haven't done these in years.

I just fear the part where you have to press the vein after opening the lid to stop blood gushing all over the patient.

Any advice?
JFDI? It's a practical skill, you can't improve until you do it.

Ask someone more senior to supervise you if you think that might help, but ultimately this is a clinical skill you're going to have to get to grips with and the only way you can do that is by physically doing it. There will be some occasions when you'll miss or things get messy. This is a normal part of the learning process and every doctor has gone through it at some point.

Pressing on the vein to stop bleeding is a good technique - what are you afraid might happen?

Last minute pedantry: it's "paeds".
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Anonymous #1
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(Original post by ecolier)
It will come with practice and experience.

Are you at med school or starting FY1? If you're at med school there'll be plenty of opportunities to practice on dummies; if you're starting FY1 then make the most of the shadowing weeks to practise under the watchful eye of the outgoing FY1!
(Original post by Democracy)
JFDI? It's a practical skill, you can't improve until you do it.

Ask someone more senior to supervise you if you think that might help, but ultimately this is a clinical skill you're going to have to get to grips with and the only way you can do that is by physically doing it. There will be some occasions when you'll miss or things get messy. This is a normal part of the learning process and every doctor has gone through it at some point.

Pressing on the vein to stop bleeding is a good technique - what are you afraid might happen?

Last minute pedantry: it's "paeds".
Med student

I just don't want to cause harm to the patient. I don't mind embarrassing myself, staying late or coming early to practice, it's just harming the patient.

When doing a canula, after putting it in and before opening the screw in cover , occluding the vein gives me trouble. It's just having to press down and occlude, especially on a patient who is overweight. I have seen so many of us struggle with that on models and sometimes under supervision, and a big amount of blood can come out.

A couple of years ago , i found myself quite ill and someone accidentally had done that on me. I tried to smile and give the person confidence but it was a mess. Since then, nobody has really had the chance to get much practice at all, and i think i have this mental block.

I must convey my thanks to both of you, gems along with some of the others on this forum! And sorry, i always misspell paeds and haem!
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Democracy
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(Original post by Anonymous)
Med student

I just don't want to cause harm to the patient. I don't mind embarrassing myself, staying late or coming early to practice, it's just harming the patient.

When doing a canula, after putting it in and before opening the screw in cover , occluding the vein gives me trouble. It's just having to press down and occlude, especially on a patient who is overweight. I have seen so many of us struggle with that on models and sometimes under supervision, and a big amount of blood can come out.

A couple of years ago , i found myself quite ill and someone accidentally had done that on me. I tried to smile and give the person confidence but it was a mess. Since then, nobody has really had the chance to get much practice at all, and i think i have this mental block.

I must convey my thanks to both of you, gems along with some of the others on this forum! And sorry, i always misspell paeds and haem!
You're welcome.

I think you're rather over-thinking this and I still don't understand at what point you think harm is being caused. Is it the physical co-ordination aspect of occluding the vein which is worrying you, or do you think the actual act of occlusion is going to cause some sort of harm?

You're a medical student and you're there to learn clinical skills; it's called a teaching hospital for a reason. Introduce yourself to the patient, explain that you're a student and outline what you'd like to do. At this point you just need to give it a go. The more you practice, the more it will become ingrained in your muscle memory. You'll stop fumbling for bits and pieces and you'll eventually do it all in one fluid motion. But you need to take that first step and actually start practising.
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Ghotay
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You don’t have to occlude the vein. I often do, but if I feel like I don’t have enough hands or the situation is awkward I just put a load of gauze under the cannula and let the patient bleed
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Helenia
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The patient losing a few mls while you cap off the cannula is messy, yes, but isn't harming them - have you ever seen someone do a CVC or a Seldinger technique art line? That's messy!. Will make you unpopular with nurses though.

Try taking the cap off and putting it somewhere safe and within reach, before you start the cannulation. Or if your trust uses octopuses or other safety bungs, have them open and primed. Then you've got a hand to press on the vein while you grab the cap.
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Etomidate
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With cannulation, just withdraw the needle partially before you remove the torniqet, then apply pressure across the vein just where the length of the cannula probably ends. Zero blood.

As above, seldinger arterial lines and vascaths are where you make a real bloodbath.
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moonkatt
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If your trust uses top ported cannulas, loosely put the bung on the top port so it’s there ready to use when you've removed the needle.

Cannulation is fiddly, as others have said, the only way to get better at doing it is practice.
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Anonymous #1
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(Original post by Democracy)
You're welcome.

I think you're rather over-thinking this and I still don't understand at what point you think harm is being caused. Is it the physical co-ordination aspect of occluding the vein which is worrying you, or do you think the actual act of occlusion is going to cause some sort of harm?

You're a medical student and you're there to learn clinical skills; it's called a teaching hospital for a reason. Introduce yourself to the patient, explain that you're a student and outline what you'd like to do. At this point you just need to give it a go. The more you practice, the more it will become ingrained in your muscle memory. You'll stop fumbling for bits and pieces and you'll eventually do it all in one fluid motion. But you need to take that first step and actually start practising.
I just feel as though it's an impossibly difficult thing to do, harder than any OSCE/PACES/written exam. I don't know how rational that is. I just feel as though being able to put a needle into another human being is such an enormous thing, that only a select few are capable off. It's just a big mental barrier i need to get over with practice.

I don't feel as though i have room to make any mistake. We get signed-off after every attachment, and although my med school says we can practice and then get a formal assessment on a particular skill done once we feel confident, the actual hospitals vary wildly. I seem to have gotten a handful of very keen ones. It's sad because you feel like you can't freely ask stupid questions, you can't get involved as much with certain types of firms and consultants because they might give you a fail or borderline. I had a bad experience as a third year, after two years pre-clinical where the consultant was notorious for being harsh. I was asked to present and gave it my best on a number of occasions and he only mocked my presentation. I even asked him for advice how to improve and he just gave me a generic "it's not good". Never explained how to do it properly mind, and i've struggled ever since on presenting. Hopefully will iron it out this year. That was my first clinical firm, and instilled fear in all of us.
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Anonymous #1
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(Original post by Ghotay)
You don’t have to occlude the vein. I often do, but if I feel like I don’t have enough hands or the situation is awkward I just put a load of gauze under the cannula and let the patient bleed
Could anyone else confirm if i should do this? I am terrified of just letting the patient bleed, because i have eczema on my hands and gloves are a nightmare to put on, never mind if there's blood everywhere. You are extremely brave or calm under pressure.

(Original post by Etomidate)
With cannulation, just withdraw the needle partially before you remove the torniqet, then apply pressure across the vein just where the length of the cannula probably ends. Zero blood.

As above, seldinger arterial lines and vascaths are where you make a real bloodbath.
How much would you say partially is? A millimetre or two? I worry by withdrawing i might get out of being in the vein.

Do junior doctors have to put in seldinger arterial lines?
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Anonymous #1
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(Original post by Helenia)
The patient losing a few mls while you cap off the cannula is messy, yes, but isn't harming them - have you ever seen someone do a CVC or a Seldinger technique art line? That's messy!. Will make you unpopular with nurses though.

Try taking the cap off and putting it somewhere safe and within reach, before you start the cannulation. Or if your trust uses octopuses or other safety bungs, have them open and primed. Then you've got a hand to press on the vein while you grab the cap.
(Original post by moonkatt)
If your trust uses top ported cannulas, loosely put the bung on the top port so it’s there ready to use when you've removed the needle.

Cannulation is fiddly, as others have said, the only way to get better at doing it is practice.
I just fear that getting blood all over the patient is going to reinforce the fear i have, and some patients may feel a lot worse by having that much blood come out.

I hope i don't have to do a seldinger arterial line!
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Democracy
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(Original post by Anonymous)
I just feel as though it's an impossibly difficult thing to do, harder than any OSCE/PACES/written exam. I don't know how rational that is. I just feel as though being able to put a needle into another human being is such an enormous thing, that only a select few are capable off. It's just a big mental barrier i need to get over with practice.

I don't feel as though i have room to make any mistake. We get signed-off after every attachment, and although my med school says we can practice and then get a formal assessment on a particular skill done once we feel confident, the actual hospitals vary wildly. I seem to have gotten a handful of very keen ones. It's sad because you feel like you can't freely ask stupid questions, you can't get involved as much with certain types of firms and consultants because they might give you a fail or borderline. I had a bad experience as a third year, after two years pre-clinical where the consultant was notorious for being harsh. I was asked to present and gave it my best on a number of occasions and he only mocked my presentation. I even asked him for advice how to improve and he just gave me a generic "it's not good". Never explained how to do it properly mind, and i've struggled ever since on presenting. Hopefully will iron it out this year. That was my first clinical firm, and instilled fear in all of us.
It's really not impossible at all and you can do it. This really sounds like overthinking which has led to anxiety and a mental block.

I'm sorry to hear of your bad experience - clearly that consultant shouldn't have talked to you like that, there's no place for it and it certainly doesn't count as "teaching". There is room for making mistakes and you should be able to ask questions freely. People like the individual you're describing don't represent the majority of consultants.

Re: arterial lines and the Seldinger technique - this is not something which is expected of FY1s. It's something you can learn as an FY1 or FY2 under supervision if you do an anaesthetics or ICM job, but it's not a core procedure. Obviously if you go on to ACCS then you'll need to start developing these skills, but that's a long way off.
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Etomidate
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(Original post by Anonymous)
Could anyone else confirm if i should do this? I am terrified of just letting the patient bleed, because i have eczema on my hands and gloves are a nightmare to put on, never mind if there's blood everywhere. You are extremely brave or calm under pressure.



How much would you say partially is? A millimetre or two? I worry by withdrawing i might get out of being in the vein.

Do junior doctors have to put in seldinger arterial lines?
So when you insert a cannula, you slide the cannula off the needle into the vein, yes? Just advance the cannula so that the needle is withdrawn half of the way out. This occludes the cannula and stops blood coming out and gives you time to take the tourniquet off and occlude the vein.

You would only expected to do arterial lines if you do anaesthetics/ITU.
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girl_in_black
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(Original post by Anonymous)
Could anyone else confirm if i should do this? I am terrified of just letting the patient bleed, because i have eczema on my hands and gloves are a nightmare to put on, never mind if there's blood everywhere. You are extremely brave or calm under pressure.
You can do this and if you are fast and have you cap ready, there will not be much blood loss. If this is the only way for you to overcome the mental block, start off by doing it this way - realistically, how much blood can a person lose through a blue or pink cannula in the 5 seconds it will take you to take to take out the needle and put on the cap?

Once you are confident with the process, you can work on making it more slick and less messy. In addition to occluding the vein, another thing you can do is to tip up the part of the cannula above the catheter (and if it is on the hand, you can also tip the hand up against gravity) - this way you might even avoid bleeding completely.

I'm a little confused about you putting on gloves when there is blood though - you put them on before starting the procedure, surely?
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nexttime
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(Original post by Anonymous)
Could anyone else confirm if i should do this? I am terrified of just letting the patient bleed, because i have eczema on my hands and gloves are a nightmare to put on, never mind if there's blood everywhere. You are extremely brave or calm under pressure.
Of course its fine - they probably wouldn't even lose a millilitre of blood! As mentioned, the only problem might be that you get a drop on the sheets. To actually cause harm to the patient you'd have to sit around not attaching the connector for many minutes.

I have no idea why the idea of seeing even a drop of blood freaks you out so much. There are so, so many other much bloodier procedures in medicine, not to mention childbirth!
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Ghotay
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If you're in a big juicy vein then sometimes you will get a fair flow of blood but quite honestly even with a properly-situated cannula if it's a smallish vein you quite often don't get any blood come out.

You seem to have really hyped up this procedure in your head. I remember being very worried before I started doing cannulas and venepuncture as well. Something that helped me is the saying "You can't do any harm with a geren needle". This isn't 100% strictly true of course, but it is broadly true that you would usually either have to try rather hard or be very unlucky to do anyone lasting damage with a green needle. A green cannula is very small and thin and not very long. Even if you hit a structure you shouldn't, like an artery or a tendon, the chances of there being any adverse consequences beyond some pain for a few days is very very slim. This isn't to say that you shouldn't be careful, just that even the WORST CASE scenario for peripheral cannulation really isn't that bad.

If it's worrying you that much maybe it would be worth reaching out to your medical school to see if you can get some additional support/supervision/practice. That's what I did and it was helpful
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