Tuesday, May 1, 2007

Switching Seats

It was only a little baby 22 gauge, but it felt like I was pushing a garden hose through sand once I got through the skin. She winced in pain and let out a yelp, fighting the urge to pull her hand back from mine. She grits her teeth, sucking in air sharply with each motion of the needle.

No flash.

I look at the back of the hand, where I had carefully landmarked the tiny vein just a few seconds ago. It was obvious before, but now that I have inserted the sharp under her skin it has retreated to some unknown depth. It doesnt want to be found.

I try to ignore the woman's painful cries and continue my search for the elusive vessel. I use the tip of the needle like a probe, moving slightly to the left and upwards as I get closer... as I must be getting closer to the goal. Where the hell is that goddamn flash? I elect to insert more of the needle, reach farther underneath the skin. Another painful yelp from the patient. She is becoming less able to control pulling her hand back, and I almost lose the needle altogether.

"Just one more second ma'am, I've almost got it. Please try and stay still."

I dont have it though. There comes a point where - after inserting the needle and missing - careful correction becomes blind hunting and hoping. I have lost sight of where the vein was supposed to have been, and now I am sticking in the dark. I've crossed that line. One last time I move the needle upward and forward.

A splash of blood into the tiny chamber.

I wait. Sometimes the small needles take a long time to fill up the flash chamber. The lumen of the needle is very small, it takes time. Just wait a few more seconds, you'll see, it'll fill right up and the IV will be done. ...It shouldnt be taking this long, though. I must have gone right through the vein. One more tiny motion and it is confirmed as a small bulge grows on the woman's hand. Shit.

My preceptor raises an eyebrow. I've missed twice now, it's time for him to take over. I carefully climb over the monitor cables as we switch positions: me into the airway seat and him to the bench. I watch from the penalty box.

He assesses her arm, selects a location, and inserts the needle. Easy as pie, the flash chamber fills right up and the catheter slides without a hitch. The safety needle moves back and locks into position. ...The familiar clicking sound of a successful IV.

My preceptor lets out a little chuckle, smiling at me.

I'm never going to hear the end of it.


Podmedic said...

The thing you have to remember is that everyone misses. If they say they don't, they're lying. Sometimes it seems like every patient I get needs two sticks to get a line.

And there are other times when I get even the tiniest vein on the first try. This is one of those "get back on the horse" moments.

Eventually you will start having a favorite "go to" iv site on difficult sticks. But -- you will still miss them sometimes.

Great blog -- keep em coming!

Blue Ridge Medic said...

I feel your pain. I have been riding 2nd man for a while as an Intermediate, but my Paramedic partner lets me do about anything I think I can handle. I finish my class in 2 weeks, and then it will be time for me to "switch seats" as you put it. Good luck to you.


Brett said...

Look at it like this... you know how if you struggle to open a jar, then someone else trys and they get it open like it was nothing... well you just hit all the bad veins only leaving him the good one.. at least your not bleeding all over the truck

james said...

IVs are crazy. Sometimes you'll have streaks of days, even weeks, where you'll be able to hit anything with amazing accuracy.

Other times you'll have streaks where you can't hit the side of the barn.

Its frustrating.

Zac said...

Yep, I hear ya. It sucks too because you KNOW how much it hurts...