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.