Cannula injections (very slight rant)
Discussion
Had a cannula inserted in the back of my hand today for pain relief and to make me drowsy.
When the injections were pumped in to the cannula the doctor was surprised that a
lump appeared on my wrist. I'm presuming this was the pain relief fluid.
If so this explains to me why I didn't get and pain relief and felt every bloody thing going on!
I don't think the cannula was in a vein. Is this possible?
When the injections were pumped in to the cannula the doctor was surprised that a
lump appeared on my wrist. I'm presuming this was the pain relief fluid.
If so this explains to me why I didn't get and pain relief and felt every bloody thing going on!
I don't think the cannula was in a vein. Is this possible?
Bugger! I suppose once he pumped them in, he couldn't really do anthything about it. He even checked my other wrist to see if there was a lump on that one. I think he knew as he started to smooth out the lump. I've had one before and never felt the drugs being pumped in, this time I felt all three.
I had one yesterday prior to ACL surgery. I was asked if a 4th year student could watch yeah no problem. A few minutes later I was asked is she could pop the canular in. She made a balls of it and they had to go for my other hand. Rather than been put on the spot it would better to be asked before if you objected when no student is present. I know they have to learn and there is a good chance I would say yes anyway we'll not sure now after having it messed up.
for a doctor or nurse It can be tricky..... I'm 52 and I've been doing my own IV since I was 13...at least once a week.. I consider myself an expert.
..... BUT I miss the vein now and then.... I obviously know straight away that I've missed, but it's quite easy to think you've got it, but in fact the needle has gone through into tissue, or to the side....
The vein can and does move....
..... BUT I miss the vein now and then.... I obviously know straight away that I've missed, but it's quite easy to think you've got it, but in fact the needle has gone through into tissue, or to the side....The vein can and does move....
Edited by Quinny on Wednesday 1st October 22:12
You are a brave man. I couldn't do it. (A nurse did mine)
What annoys me more now though, the doctor knew what had happened yet he still put the other two injections in, knowing that they were going into tissue and not the vien. Then! He carried on with the procedure knowing the pain killers wouldn't work, they would just slowly disperse into soft tissue.
Hey ho! Never again, I'll say something if it does. Trouble is being at a dissavantage in a hospital, you want help from them.
What annoys me more now though, the doctor knew what had happened yet he still put the other two injections in, knowing that they were going into tissue and not the vien. Then! He carried on with the procedure knowing the pain killers wouldn't work, they would just slowly disperse into soft tissue.
Hey ho! Never again, I'll say something if it does. Trouble is being at a dissavantage in a hospital, you want help from them.
oilandwater said:
You are a brave man. I couldn't do it. (A nurse did mine)
What annoys me more now though, the doctor knew what had happened yet he still put the other two injections in, knowing that they were going into tissue and not the vien. Then! He carried on with the procedure knowing the pain killers wouldn't work, they would just slowly disperse into soft tissue.
Hey ho! Never again, I'll say something if it does. Trouble is being at a dissavantage in a hospital, you want help from them.
Not brave mate...just got fed up of medical staff using me as a pin cushion...... I have a medical condition that requires the injection, so it made sense to NOT have to go to the hospital all the time etc etc.....What annoys me more now though, the doctor knew what had happened yet he still put the other two injections in, knowing that they were going into tissue and not the vien. Then! He carried on with the procedure knowing the pain killers wouldn't work, they would just slowly disperse into soft tissue.
Hey ho! Never again, I'll say something if it does. Trouble is being at a dissavantage in a hospital, you want help from them.
Completely different to your situation obviously...
The one time you need them to hit the vein, they miss, not a good experience.... FWIW, the best folk at the hospital for getting the vein first time every time are the phlebotomist......
A doctor or nurse with enough experience, should be able to tell if the fluid is going into tissue......
the best people at getting cannulae into veins are no particular order
-A+E Nurses -
-Anaesthetists
-ODPs/ Anaesthetic Nurses
-Phlebotomists who can cannulate
anecdote time
when working in A+E i was asked once by a Paramedic how many cannulas i'd done this was i nthe days when Paramedics had to keep a log book of all the 'paramedic skills used' a hang over from the days pre Paramedic registration when it was all very controlled by the LAPSC Doctors- I answered I'd stopped counting after about 200 because it was only 20 to get signed off and a busy shift could mean a dozen or more venepunctures or cannulas ... to date i've done thousands and that includes 4 years working on acute wards rather than A+E / assessment and 2 years out of practice.
-A+E Nurses -
-Anaesthetists
-ODPs/ Anaesthetic Nurses
-Phlebotomists who can cannulate
anecdote time
when working in A+E i was asked once by a Paramedic how many cannulas i'd done this was i nthe days when Paramedics had to keep a log book of all the 'paramedic skills used' a hang over from the days pre Paramedic registration when it was all very controlled by the LAPSC Doctors- I answered I'd stopped counting after about 200 because it was only 20 to get signed off and a busy shift could mean a dozen or more venepunctures or cannulas ... to date i've done thousands and that includes 4 years working on acute wards rather than A+E / assessment and 2 years out of practice.
mph1977 said:
the best people at getting cannulae into veins are no particular order
-A+E Nurses -
-Anaesthetists
-ODPs/ Anaesthetic Nurses
-Phlebotomists who can cannulate
anecdote time
when working in A+E i was asked once by a Paramedic how many cannulas i'd done this was i nthe days when Paramedics had to keep a log book of all the 'paramedic skills used' a hang over from the days pre Paramedic registration when it was all very controlled by the LAPSC Doctors- I answered I'd stopped counting after about 200 because it was only 20 to get signed off and a busy shift could mean a dozen or more venepunctures or cannulas ... to date i've done thousands and that includes 4 years working on acute wards rather than A+E / assessment and 2 years out of practice.
No chance ODP and A&E nurses are better than paramedics! Not a chance. When do they ever put a needle in under pressure? If they can't get one in then they ask a doctor. Not an option for a paramedic. How often do they cannulate on their knees in poor light, at awkward angles? -A+E Nurses -
-Anaesthetists
-ODPs/ Anaesthetic Nurses
-Phlebotomists who can cannulate
anecdote time
when working in A+E i was asked once by a Paramedic how many cannulas i'd done this was i nthe days when Paramedics had to keep a log book of all the 'paramedic skills used' a hang over from the days pre Paramedic registration when it was all very controlled by the LAPSC Doctors- I answered I'd stopped counting after about 200 because it was only 20 to get signed off and a busy shift could mean a dozen or more venepunctures or cannulas ... to date i've done thousands and that includes 4 years working on acute wards rather than A+E / assessment and 2 years out of practice.
Ruskie said:
No chance ODP and A&E nurses are better than paramedics! Not a chance. When do they ever put a needle in under pressure? If they can't get one in then they ask a doctor. Not an option for a paramedic. How often do they cannulate on their knees in poor light, at awkward angles?
There was a thread on here a while ago too saying that paramedics are better at oxygen tubes in windpipes than doctors tooThe OP should deffo of had a paramedic not a doctor
Ruskie said:
No chance ODP and A&E nurses are better than paramedics! Not a chance.
quality and quantity suggests otherwise Ruskie said:
When do they ever put a needle in under pressure?
about as often as a paramedic Ruskie said:
If they can't get one in then they ask a doctor.
why would an A+E Nurse get someone with considerably less experience to do it ? until an A+E doctor is a St3+ they will have considerably less experience than an experienced Nurse or Paramedic - maybe in a Big City A+E department with 24/7 full shift Middle grade cover you've got Registrars available to do things like difficult cannulasit really amazes me how many other HCPs believe that Nurses 'ask a doctor' to do anything they struggle with . the reality in most settings is that Foundation Doctors and Core trainees are more liely to be asking the Nurses for assistance.
Also the levels of medical cover in hospitals out of hours means that Medical assistance if often significantly delayed unless your patient is peri arrest
Ruskie said:
Not an option for a paramedic. How often do they cannulate on their knees in poor light, at awkward angles?
admittedly extrication is a less common activity for the A+E nurse but suprisingly enough i've underttaken a number of extrications in the A+E car parkls where people have thrown their poorly relative / firend in the bakc of the car and headed for A+E rather than dial 999 ... we'll also conveniently ignore those who decide to collapse in awkward places in the department
and the ' we couldn't get a line ' handovers where despite the average A+E cubicle being not particuarly better lit than the back of the Ambulance before leaving scene the triage nurse manages to get bloods / line - in some cases the fact the crew have warmed them up has helped but that doesn;t explain them all
as I previous said A+E nurses lose count of the number of cannulas they do and of the number of other 'leet skillz' like suturing as once they've done their 20 /50 /100 to get signed off the numbers add up
numtumfutunch said:
Ruskie said:
No chance ODP and A&E nurses are better than paramedics! Not a chance. When do they ever put a needle in under pressure? If they can't get one in then they ask a doctor. Not an option for a paramedic. How often do they cannulate on their knees in poor light, at awkward angles?
There was a thread on here a while ago too saying that paramedics are better at oxygen tubes in windpipes than doctors tooThe OP should deffo of had a paramedic not a doctor
while this is straying from cannulation i'm going to jump to the defence of paramedics here
the stats aobut the 'survuival' from Paramedic intubation vs Survivial from Pre -hospital Doctor intubation is not a straight comparison
Most Paramedics can't sedate or anaesthetise a patient (the drugs aren't in the Stat exemption, the skills aren't in the core competencies for registration) - therefore to be able to succesfully intubate a patient that patient has to be a lot 'flatter' than someone you'd made 'flat' by an RSI anaesthetic or a big whack of Ketamine ... A few Paramedics with additional education and training do have access to a wider range of drugs and treatment options but they are relatively few and far between becasue the comparator 'reasonable practitioner' remains an Immediate Care Doctor with up to 12 months anaesthetics training ( as seen in the ACCS core training for Emergency Medicine/acute medicine and one of the routes to anesthetist / Intensive care consultant - the other route being pure anaesthetic core training )
the stats aobut the 'survuival' from Paramedic intubation vs Survivial from Pre -hospital Doctor intubation is not a straight comparison
Most Paramedics can't sedate or anaesthetise a patient (the drugs aren't in the Stat exemption, the skills aren't in the core competencies for registration) - therefore to be able to succesfully intubate a patient that patient has to be a lot 'flatter' than someone you'd made 'flat' by an RSI anaesthetic or a big whack of Ketamine ... A few Paramedics with additional education and training do have access to a wider range of drugs and treatment options but they are relatively few and far between becasue the comparator 'reasonable practitioner' remains an Immediate Care Doctor with up to 12 months anaesthetics training ( as seen in the ACCS core training for Emergency Medicine/acute medicine and one of the routes to anesthetist / Intensive care consultant - the other route being pure anaesthetic core training )
mph1977 said:
Ruskie said:
No chance ODP and A&E nurses are better than paramedics! Not a chance.
quality and quantity suggests otherwise Ruskie said:
When do they ever put a needle in under pressure?
about as often as a paramedic Ruskie said:
If they can't get one in then they ask a doctor.
why would an A+E Nurse get someone with considerably less experience to do it ? until an A+E doctor is a St3+ they will have considerably less experience than an experienced Nurse or Paramedic - maybe in a Big City A+E department with 24/7 full shift Middle grade cover you've got Registrars available to do things like difficult cannulasit really amazes me how many other HCPs believe that Nurses 'ask a doctor' to do anything they struggle with . the reality in most settings is that Foundation Doctors and Core trainees are more liely to be asking the Nurses for assistance.
Also the levels of medical cover in hospitals out of hours means that Medical assistance if often significantly delayed unless your patient is peri arrest
Ruskie said:
Not an option for a paramedic. How often do they cannulate on their knees in poor light, at awkward angles?
admittedly extrication is a less common activity for the A+E nurse but suprisingly enough i've underttaken a number of extrications in the A+E car parkls where people have thrown their poorly relative / firend in the bakc of the car and headed for A+E rather than dial 999 ... we'll also conveniently ignore those who decide to collapse in awkward places in the department
and the ' we couldn't get a line ' handovers where despite the average A+E cubicle being not particuarly better lit than the back of the Ambulance before leaving scene the triage nurse manages to get bloods / line - in some cases the fact the crew have warmed them up has helped but that doesn;t explain them all
as I previous said A+E nurses lose count of the number of cannulas they do and of the number of other 'leet skillz' like suturing as once they've done their 20 /50 /100 to get signed off the numbers add up
How many times in a 30 year career would an A&E nurse cannulate a child in cardiac arrest? Leaving aside whether it is beneficial. It's indicated and an available as an option.
That's pressure to me.
How many times would they cannulate someone with a peri - arrest triple AAA, 30 mins from the nearest hospital?
That's pressure to me.
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