just an update from clinical

Pete495 · Dec 12, 2004

I always wondered what it would be like to start an IV in the middle of a case when patient is draped and everything. I would think it's always got to be a difficult stick, and also difficult to ask people to move who are performing the surgery so you can start another damn IV. Or do they always put the arms on armboards if possible? I was just curious.

Maybe you should get one of those IV illuminators. Have you seen them? Probably be good for your situation under the drapes. I'm not saying you need it, but here is the site in case any body is interested.

https://venoscope.secure.powweb.com/content/venoscope.php

Personally, I don't think I will take the time to use it, and it can only illuminate the superficial veins really anyway. Still, when you have nothing on some of those diabetics with PVF, it probably would help.

By the way, I will probably use your expression when the time comes. thanks. I will file that one away for later.

classicaldreams · Dec 12, 2004

I thought I would just check in and let you all know I am still alive and kicking. . .
I MUST HAVE LOST MY DAMN MIND.....
seriously what do you say to that.....
Alansmith52,
I'm glad to hear you are surviving! And thank you for the good laugh. Certainly is a phrase I will tuck away for the future.
Classicaldreams

kjt2004 · Dec 12, 2004

You are funny:rotfl:

Thanks for the laugh, i nedded that!

I thought I would just check in and let you all know I am still alive and kicking.
Well so far so good I guess, well that is if you don't count the bleeding ulcer I had after the first couple of weeks of clinical. it was intresting we arrived at our clinical site and within two weeks they had us on the call schedule. wheeeeww how I ever got through that period of time I don't know. I heard once that in all things you have to go through stupid to get to smooth. hopefully I've been through stupid now.
our cases started at 0730 but I was there at 0450 on the day that was supposed to be my first to actually take a patient. the most simple thing like turning on the lights in the OR having never worked in there before took me forever.
Now after about 4 months I can say I feel pretty comfortable with most asa 1 or 2 type cases. not to say I havn't done 3 and 4's as well but I like to consult who I am with alot more durring those cases.
If there was one word to the wise I could pass on it would be a phrase. this is a phrase you can use anytime you feel like your in hot water with an MD attending or CRNA attending. most of which have somewhat pathological personalities I've discovered when comes to teaching people they deem as less signifcant than themselves... are you ready here it comes.
I MUST HAVE LOST MY DAMN MIND.....
seriously what do you say to that..... since most of the time it is sensless to try and defend you self I usually just say this one, explitive deleated sometimes. I love it becuase it immeadeatly stops the current persucution but at the same time in my own mind I am able to mock their pride by saying this and they don't even know it.
for example one day an attending helped me to start a case the patient the patient had an IV but not a great one so I was told to try and start another one. well once I got everything done to make sure the patient could sustain life ie vent, gas . ect I turned around that arms were tucked... and theye were draping well I went under the drapes in the dark with a 20 ga and tried unsuccessfully. I finanlly said to myself (like a fool) oh well she already has an IV anyway and the case really almost over so what the heck.
My attending came back in at the end of the case and said didn't I tell you to start another IV.???? Now at this point I have a choice to make do I tell her about my delima and what happend or do I say> I must have lost my mind... I actually tried to discuss the reason as to why I was deliquent in my IV starting task but quickly relized she was not havin it. so I defered to the I lost my mind techinque and it was immediatly over.
its tragic really that somtimes you cant reason with them. becuase a teaching moment is lost. in hind site I really needed to get another IV on an ectopic but at the moment I didn't understand what I do understand now.
well such is life and one day stupid will pass and we will all get to smooth I hope.

skipaway · Dec 12, 2004

I always wondered what it would be like to start an IV in the middle of a case when patient is draped and everything. I would think it's always got to be a difficult stick, and also difficult to ask people to move who are performing the surgery so you can start another damn IV.

Your patient is always number one. If you need something like an IV in the middle of the case and it's for patient safety, most if not all surgeons are not going to have a problem stopping and getting out of your way for the few minutes it takes. Patients with armboards are of course, much less of a distraction but even if tucked, you can still do it. Of course, if you've planned ahead and know you need more access, do so before all the tucking and draping. Just make sure your gas and vent are going first. All the other stuff can wait.

mwbeah · Dec 12, 2004

Your OR nurses shouldn't be positioning the patient without your OK. Do what you need to do and then say "you can position now", no matter how long it takes you. Don't let them rush you, cuz lord knows you wait long enough on them during room turnover. Speed comes with time, make sure you got what you need. If you need an extra hand, have the OR nurse start the IV (they are part of the team). Until your satisfied, the patient doesn't move or is positioned. Also, eventually you will come across a case where there is a large amount of unexpected blood loss and you will have to crawl under the drape or ask the surgeon to wait while you start a large bore and an A-line. Part of the learning process is speaking up and caring for your patient appropriately. We all have been there, your voice will become "louder" the more your in the OR.

Also, when you forget to do something, that's OK. Just tell your staff you forgot and take the lashings (unfortunately the lashings reinforce the learning).

Mike

gaspassah · Dec 13, 2004

since most of the time it is sensless to try and defend you self

it's funny, when i was reading this it reminded me of what i was telling some students the other day.

sometimes you can do what is right, supported by the literature and you are still wrong. i have on occasions used a reference to back up what i was doing but was met with...i've done this x amount of years this way and never heard of that way.

i know experience is a big teacher, but isnt there something to evidenced based practice. just because it was done that way for so long doesnt mean that there arent better or newer ways of doing things. that's all. and not that the old way doenst work.

d