14 hour shift in medicine FML (2 Viewers)

[Havox]

Jesus hope that 14 hrs thing doesn't come to me

Have a rostered 14.5 hour shift this week. Yay...

 

[royalgoyal]

come on guys doing med at any uni is good isnt it?

 

[royalgoyal]

its like the most wanted degree every1 is hunting for

 

[Kiraken]

come on guys doing med at any uni is good isnt it?

Yes

 

[tofusenpai]

Would the hours be similar for a paediatrician?

 

[bangladesh]

Have a rostered 14.5 hour shift this week. Yay...

woop go hav! do us proud

 

[Havox]

woop go hav! do us proud

Tbh, I don't think it's particularly safe. Most people are completely stuffed after 10 hours looking after their own patients let alone randoms you don't know.

 

[Medman]

Anyway I'm glad this thread was posted and has shed some light on the reality of medicine. What sort of training did you receive for venepuncture/BC/ABG/VBG collection? From the student doctors I've taught venepuncture to they were given one session and then thrown in a hospital where it is assumed they know how to collect and cannulate which is quite horrible for them and the patients. These skills require months/years to master and it sounds like better education needs to be applied to perform these techniques.
#rantover

I only did 2 ABGs in med school and both were not successful but was very lucky to learn the technique well from the supervising doctors. My 3rd ABG was when I was a doctor and succeeded very well. Cannulation is a different beast all together. You are taught one technique in medical school which seem to translate poorly to what the actual job entails. I can ensure you if I listened to exactly what medical school has taught for cannulation, I would fail half my cannulas. It requires practice and practice and practice to become competent. It also doesn't help that medical schools don't teach it properly, they need to use interns/RMOs to teach cannulation because they are the ones doing most of the cannulas.

 

[Medman]

Have a rostered 14.5 hour shift this week. Yay...

Just remember to do the important things first and don't waste too much time on cannulas. GOGOGO!

 

[Ethicks]

I only did 2 ABGs in med school and both were not successful but was very lucky to learn the technique well from the supervising doctors. My 3rd ABG was when I was a doctor and succeeded very well. Cannulation is a different beast all together. You are taught one technique in medical school which seem to translate poorly to what the actual job entails. I can ensure you if I listened to exactly what medical school has taught for cannulation, I would fail half my cannulas. It requires practice and practice and practice to become competent. It also doesn't help that medical schools don't teach it properly, they need to use interns/RMOs to teach cannulation because they are the ones doing most of the cannulas.

I disagree, a well rounded nurse who has 20+ years cannulation experience is what you need but I suppose there is a lot of big headed people who don't want to be taught by someone 'lower' these type of people will have a VERY hard time in medicine and can expect one hell of a time. You are right about the way you are taught I can vouch for that based on the skills I have seen from USYD rural students which as I said before it not their fault. Just don't try and take blood or cannulate a vein in the wrist which I have seen there is ALWAYS somewhere else. You can always run a VBG I think there is some ignorance surrounded by ABG being necessary when a VBG in routine cases is sufficient.

Let me stop my rant before I get onto something else..

P.S If you want to be good at venepunture and cannulation for that matter it's about what you feel not what you see too many people use their eyes and go for the blue line #facepalm

 

[Havox]

Just don't try and take blood or cannulate a vein in the wrist which I have seen there is ALWAYS somewhere else.

If it works it works. Sometimes beggers can't be choosers and that's the only vein.

I found myself more confident as a doctor than as a medical student, even if it was just a title change and naturally was more successful. I quite enjoy doing vascular procedures actually. I agree with Medman, the textbook technique is bullshit and never actually works. Learn by doing and experimenting to see what works for you, everyone has a different technique.

 

[Kiraken]

Tbh u should get the hang of cannulations pretty quickly by the time u have gotten a few hours on the ward doing them

The supervisor from my anaesthetics rotation taught me a lot better than any textbook teaching but tbh i think med schools now are shifting towards that more practical focus anyway

 

[Medman]

No nurses I know do cannulation in my hospital but if they do have that experience I do welcome them to teach. I definitely agree venepuncture and cannulation could be done by nurses (female catherisation can be done in my hospital). Physician assistants are another option and according to a friend have just graduated this year. I am looking forward to working with them but I am worried about deskilling if everything is palmed to them.

Superficial veins especially in the hand require you to go almost at horizontal level. I've cannulated a few hand veins which were so superficial I actually hit the vein after going in by 1mm or less.

I do agree with Havox regarding the title change. I have a lot more confidence in my abilities and I haven't failed too many as a result. I always go in thinking I will succeed as I did not have that attitude in med school. It's a challenge to be overcome but you always need to consider it from a patient's perspective as well (Don't poke them too many times.).

 

[Ethicks]

That is total ignorance, why is it myself and the person who taught me NEVER had to take blood from the wrist? Because we always found somewhere else being someone who is 'fairly' new should not be taking anything from the wrist what happens when you hit a nerve and the patient can no longer move their finger(s)? Aside from that the veins in the wrist aren't deep and most people will go right through them.

No nurses I know do cannulation in my hospital but if they do have that experience I do welcome them to teach. I definitely agree venepuncture and cannulation could be done by nurses (female catherisation can be done in my hospital). Physician assistants are another option and according to a friend have just graduated this year. I am looking forward to working with them but I am worried about deskilling if everything is palmed to them.

Superficial veins especially in the hand require you to go almost at horizontal level. I've cannulated a few hand veins which were so superficial I actually hit the vein after going in by 1mm or less.

I do agree with Havox regarding the title change. I have a lot more confidence in my abilities and I haven't failed too many as a result. I always go in thinking I will succeed as I did not have that attitude in med school. It's a challenge to be overcome but you always need to consider it from a patient's perspective as well (Don't poke them too many times.).

It's my knowledge that medical students only learn the butterfly technique but you are indeed correct that when taking from the hand you want to go in flat, at times you are over the vein and need to go down a little to enter it. Most of the nurses at my hospital were taught cannulation whilst not all knew it a lot did and there were ones who had been doing it for years. To be good at your profession you want to master these techniques most of the blood is collected daily by pathology people so if you order everything you need for the rounds then technically you only need to collect unless you missed something/it's needed urgently.

You need to be confident at everything you do, the moment you are not expect failure

And a MASSIVE tip to all medical students when using butterfly needles attach a syringe to the end and slowly draw the blood - vacuum containers on the end are USELESS especially with veins that are not vascular. You can then attach a transfer device to put the blood in the tubes then invert them as per normal. This method will save you a lot of hassle in the long run with having to try again etc you can get more suction from a syringe than what is In the vacuum of a tube.

 

[Bearman]

I disagree, a well rounded nurse who has 20+ years cannulation experience is what you need but I suppose there is a lot of big headed people who don't want to be taught by someone 'lower' these type of people will have a VERY hard time in medicine and can expect one hell of a time. You are right about the way you are taught I can vouch for that based on the skills I have seen from USYD rural students which as I said before it not their fault. Just don't try and take blood or cannulate a vein in the wrist which I have seen there is ALWAYS somewhere else. You can always run a VBG I think there is some ignorance surrounded by ABG being necessary when a VBG in routine cases is sufficient.

Let me stop my rant before I get onto something else..

P.S If you want to be good at venepunture and cannulation for that matter it's about what you feel not what you see too many people use their eyes and go for the blue line #facepalm

At UWS we have 1 half day/wk in 2nd year for procedural skills (ABG, venepuncture, cannulation, NGT, etc) which is taught by experienced nurses. Tbh I thought it was pretty good and prepared us well enough for clinical years.

 

[Havox]

That is total ignorance, why is it myself and the person who taught me NEVER had to take blood from the wrist? Because we always found somewhere else being someone who is 'fairly' new should not be taking anything from the wrist what happens when you hit a nerve and the patient can no longer move their finger(s)? Aside from that the veins in the wrist aren't deep and most people will go right through them.

I'm guessing you've never encountered someone who was truly difficult to cannulate then or had the rest of their veins massacred by everyone else having a go. Saying that it's never done is a fairly ignorant comment on its own. Obviously if you're cannulating strange spots like a wrist, foot or a thumb (yes I've seen this done), you're not doing it for the fun of it. You do it because the patient urgently needs IV access. Heck, if I could give a drug oral I'd do that. In this case, the patient was septic and needed urgent blood cultures and IV ABx for ?meningitis and happened to be old and diabetic, and a bunch of other doctors had tried and failed so I had a go. I'm guessing you're not a medical student or a JMO because I would be very careful about proclaiming ignorance.

Collecting samples right the first time will prevent those dreaded phone calls of "The ABG you just sent is clotted", I can imagine having to return to a patient and explain to them you need to do another ABG. The same thing applies for FBC if not collected properly they will clot.

Yup, I had one (Full blood count) collected by the phlebotomists this morning that clotted as well. S*** happens to everyone, most people try and do vascular procedures to the best of their ability but it's the real world and it doesn't always work out.

I disagree, a well rounded nurse who has 20+ years cannulation experience is what you need but I suppose there is a lot of big headed people who don't want to be taught by someone 'lower' these type of people will have a VERY hard time in medicine and can expect one hell of a time.

Actually I believe cannulation is taught by nurses at most clinical schools I've been to.

 

[patpatpat]

That is total ignorance, why is it myself and the person who taught me NEVER had to take blood from the wrist? Because we always found somewhere else being someone who is 'fairly' new should not be taking anything from the wrist what happens when you hit a nerve and the patient can no longer move their finger(s)? Aside from that the veins in the wrist aren't deep and most people will go right through them.

Not correct, we avoid them because they are bloody painful, easy to rupture and tend to tissue easily. If you somehow manage to hit the median or ulnar nerves when cannulating such a superficial vein, then you shouldn't be cannulating at all on your own.

I have seen emergency registrars and specialists choose that site on a few occasions even when a better vein was available simply because we wanted to save the more proximal veins for large bore access if required. I have never cannulated the wrist because I hate the veins, but I have taken blood on a couple of occasions when other veins were quite crap.

The most interesting place I've seen blood drawn from is the penis, in this case a patient with previous haemorrhagic stroke who needed an APTT urgently. We put emla on first.

 

[Schmeag]

Agree with patpatpat. For cannulation, I would look for veins in the back of the hand, the nurse's vein in the anatomical snuff box, forearm, cubital fossa, wrist, any palpable or visible upper limb vein, feet, in that order. After that, ultrasound. If not, then escalate for a less well-trodden area (external jugular). For veneouncture, I almost always use a vacutainer--less fiddly and faster, no potential blood spills, less chance of needlestick injuries and less chance for for poor samples. Otherwise I get a 20ml needle and syringe if I also need blood cultures+VBG. Haven't used a butterfly in years.

Edit:

The most interesting place I've seen blood drawn from is the penis, in this case a patient with previous haemorrhagic stroke who needed an APTT urgently. We put emla on first.

Whoa, what was the indication for the APTT and how did the patient fare? I can't even see emla helping!

 

[Medman]

I was actually in the toilet a couple of days ago and was wondering if penis veins could be used. Guess it is

 

[Schmeag]

These skills require months/years to master and it sounds like better education needs to be applied to perform these techniques.

To be honest, as someone (maybe Medman) said before, it's just practice. It's just not feasible to spend months practising IVCs and venepuncture in medical school in light of the other content that needs to be covered.

Would the hours be similar for a paediatrician?

Sorry for the delayed reply. The journey to get to the point of becoming a paediatrician would not be different, no. You would still need to get through internship, which is a mandatory year you need to go through before you become fully able to practice as a doctor. The complaints of internship are pretty well encapsulated in this thread--from what I can gather, Medman and Havox are interns and there are a few medical students commenting as well. It can be a trial by fire for some. There have been suicides. Interns have died on the road after 14-15hr shifts. Interns (and doctors in general) need to look after themselves and their colleagues. This shouldn't scare you, but it's just important that you self-reflect and have good coping strategies for the stressful times (a bit of stress is always healthy anyway).

come on guys doing med at any uni is good isnt it?

It's great fun! Unless you want to be top in the class (there's always a few), I'd advise that you study reasonably, make friends, go to the med events and enjoy the ride.

[quote="Medman]I was actually in the toilet a couple of days ago and was wondering if penis veins could be used. Guess it is[/quote]
Where there's a vein, there's a way.