Zen Masters and Gizmos

I’ve been precepting a new part-time intermediate. He needs 15 IV starts in the field. He may have five or so. (We only work together once a week.) He doesn’t quite have the hang of it yet. I tell him not to worry about missing because when you miss you learn what not to do the next time. The more you miss, the more you learn. That’s how it was when I started. I poked a lot of holes in people, spilled a lot of blood, but with time, I became pretty good at it.

IVs are, in fact, my secret pride. I consider myself an IV War Lord Zen master, capable of putting an IV into a stone. I get so good sometimes that I feel like I don’t even have to look for a vein, I just stick the needle in anywhere and the next thing I know I have blood flowing into the chamber. I am one with the vein. If I were an oil driller, Jed Clampet and JD Rockefeller would have nothing on me. So whenever I stick the catheter in and don’t see blood flashing into the chamber, I am a little shocked. I adjust it a little, pull back and then forward at a slightly different angle and blood flows into the chamber and all is right with the world again.

Now I am exaggerating a little. I don’t always get the IV, but I am really good at it. If you were to rate my various paramedic skills. I might be below average or average in some, above average in others, but in IVs, I rate nothing less than very good, even excellent. Like I said, I missed a lot in the early days to get as good as I am.

So my preceptee goes down to the EMS Conference and comes back with all these IV vein finder gadgets. He even buys one for me. I think he is expecting me to thank him graciously and be his pal, but what I am thinking is: “Grasshopper, how dare you insult your master this way?” IV Gizmo? I don’t need no stinking IV Gizmo! If I were Darth Vader, I would simple crush the insolent private with a blow to the top of the head.

I put the gizmo — an contricting band something or other — in my IV tray, but leave it in the package. There it sits all day long. I have three patients with relatively poor IV access, but I don’t even think about picking it up. First patient I miss my first try, get my second. Next patient I miss twice before I get a tiny 24 on my third try on the underside of the wrist. The patient is in failure, and needs Lasix, so the third try was okay, plus like I said, I always get the IV, so there was no question I would miss the third time. The first two misses were, ah…aberrations. Still, though, I no longer feel one with the vein.

And then the next day — first patient — I miss the first one, get the second try, and then go to put in a 2nd IV — the patient is critical — and I miss again. Next patient — I miss on the first attempt. Get a 22 on the second try. The third patient is in a rapid a-fib. I need a line so I can give Cardizem. I can’t even find a vein. I can’t see one, can’t feel one, and when I do my anatomy checks, there is not even the slightest hint of a vein hiding in the usual places. I have no confidence at all that if I just stick the catheter where I think a vein might be hiding that I will hit anything.

Note: While we have the EZ-IO, this patient isn’t sick enough for me to drill a needle into her leg bone.

I eye the tourniquet constricting gizmo. I’m thinking all right — this will be a good entry for the blog. Veteran Zen master IV man casts hubris aside and uses grasshopper’s gizmo, gets IV and learns lesson in swallowing pride.

I take the thing out of the package. It takes me a little while to figure out how it works. I finally strap it on the patient and she starts screaming. I am pinching her skin. I apologize profusely and manage to free her skin from the device. Following the instructions I roll it down the arm. I think I spot a possible vein — a small rubbery spot near the AC. I tap it a few times, run an alcohol wipe over it, and then take out a 20 catheter. I slide it right in. Nothing. No flash.

“Did you get it?” the patient asks.

“No,” I say, sounding more like a homeless man whose dog has just run than any Zen Kung Fu IV master.

“Why don’t you wait for the hospital and let the professionals do it?” she says.

Now, normally this would get me all fired up, challenging me to uphold the honor of my profession, but today, my confidence is shot. I hang my head and say, “Yeah, I guess you are right.”

I’m losing my powers.

I’M MELTING!

19 Comments

  • Brett says:

    for the professionals…. jeez… I love it when the patient says, “they always have such a hard time finding my vein” and I pop the IV in before they finish that sentence… that is priceless!

  • Girl, Dislocated says:

    I don’t know if I’ve ever commented here before, but I just wanted to let you know that I’ve declared your blog “E for Excellent” on my site. Of course, that’s probably peanuts to a published author and a Zen Kung Fu IV Master (recent slump notwithstanding) such as yourself! 🙂

  • Kelsey says:

    Holy cow! I am not the only one! I usually can always hit a vein on the first try even if I have to dig a little bit. I know were they are, and how to edge my way in. Yesterday, I missed TWO lines each on BOTH of my patients that I attended. I am calling it a “slump” that I will get over. You should too.

  • Anonymous says:

    We all miss a few here and there. Don’t let it eat you up.

  • Medix311 says:

    I know exactly how you feel. I couldn’t start an IV for the life of me last shift. Hopefully, all will be well and the planets will realign for us.

  • brendan says:

    “I AM a professional, thank you.”

  • AlisonH says:

    You know if it weren’t there you’d do just fine. Don’t let it throw you.

  • Rogue Medic says:

    What is even worse is when the veins are there, look good, and remain uncannulated. There’ll be days like this, my Momma said.

  • PC says:

    Thanks for the comments. I got my only IV so far today, but had to due a little more digging than I should have. I have the grasshopper here with me now, but no attempts for him yet.

  • fiznat says:

    I think I remember trying that gizmo on you maybe a year ago, and you having that same “youch!” reaction! Those things hurt and, apparently, don’t work so well either!

  • Anonymous says:

    As a medic student who started his ER clinicals about a month ago, this post is both encouraging and frightening… encouraging that even the pros miss sometimes, and frightening that it won’t ever be a sure thing no matter how much I practice. Did any of you have a certain breakthrough that upped your success rate, or was it just lots of practice?

  • Rogue Medic says:

    There are a lot of ways to get more practice. I worked as a phlebotomist for a while on the side. The technique they use is different, but you can decide whether to draw blood as you would start an IV, or not.Starting IVs in a moving ambulance forces you to focus more. Trying different techniques can also help.Knowing which veins are worth sticking and which should be avoided is also important. You will never go wrong improving your assessment skills.

  • Anonymous says:

    Its always reassuring to see other EMS providers admit, that some days they just cant hit a line.. During my precepting time I had a huge slump in the middle of not hitting anything, my preceptor tried a few various techniques including using a O2 tubing tied down to practice on. In the end I think it was ultimately that I stopped worrying so much about it, and realized that if I miss, I miss, worse comes to worse I always have the drill if it starts getting hairy. Since I stopped worrying so much and stressing so much about missing, my success rate went up.

  • Medic09FPC-RN says:

    Ah, yes…’wait for the professionals in the hospital’.Well, I’m one of those ‘professionals’ in the ER. And what does the patient say when I, too, can’t get a line on the first (or maybe second) stick?BTW, being a medic *and* a nurse, I’d say the professionals outside the hospital are every bit as good, or better, than the ones inside…

  • Gary says:

    “”Why don’t you wait for the hospital and let the professionals do it?” she says.”OUCH! There are days like that. Then there are the days when you can’t hit a pipe, but get a 24ga in a 90 y/o’s thumb in the back of a moving truck. Go figure. Gary

  • Anonymous says:

    I like when in the Emergency Dept when the tech or RN can’t get the line, they suggest having the MD try. Talk about the person with the least experience performing IVs =p

  • RC Huder says:

    I was paid back for all of the lines I missed in the field. I was in the hospital and they needed a line. I was on an ordinary medical ward (help). First couple missed. Phone calls for help. I volunteered to do it myself. Nope I was the patient. Three more sticks. No luck. I was beginning to worry. Please let me. I know I can get it for you. No you are the patient. Another stick no luck. Finally they called a anesthetist from the OR and he finally gets it. Seven sticks. A new worlds record. So be nice to all of those patients you could be one, one day. My favorite blind stick was at the wrist just past the base of the thumb there is a nice little jewel sitting on top of that bone.

  • Rogue Medic says:

    “My favorite blind stick was at the wrist just past the base of the thumb there is a nice little jewel sitting on top of that bone.”That’s just a different type of intraosseous access.

  • quba says:

    I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

    Margaret

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