Blood Sucking Monsters

Actual date 26/9/2012

The procedure that a junior doctor is most likely to have to perform on a patient is taking blood. It has a few names, venepuncture being the one that we were given. It doesn’t look like it should be hard. Everyone would be able to make themselves bleed a bit if they stabbed themselves with a needle. However the trick is to do it in a way that allows access to a good amount of venous (in the veins) blood without hurting the patient too much. This means your options are fairly limited as most people don’t fancy stripping off for a simple blood test. This leaves you with the arms and the hands to get blood from.

The medical school building doesn’t have the kit needed to teach us venepuncture, so we were sent off to one of our local hospitals, in fact this is the hospital where all my clinical attachments will be for the first 16 months of my course. It isn’t close. In all it’s about a 40 mile round trip and involves 2 buses, a train and a taxi. However Gareth was kind enough to drive us there so we avoided all of the public transport nonsense. We had been told by our clinical skills lecturer that we should be dressed accordingly. This meant dressing like doctors.. which to us was fantastic. We got to play doctor. In practice this meant that the 20 of us that were assigned to this session arrived wearing our freshly ironed shirts (with sleeves rolled up above the elbow, I don’t know why we don’t just buy short sleeved shirts.. but everyone seems to just roll them up), trousers and spit polished shoes. It’s a little easier for the girls, they seem to be able to wear any sort of top with a pair of trousers as long as their elbows are exposed and too much cleavage isn’t.

There is something about walking through a hospital, with a purpose, passed patients and porters with your shoes making that clip clop sound on the floor that for some reason made me a little bit proud that I was there. I’ve ended up in hospital as a patient a bit too often for my liking, and seen one too many relative pass away so I think this was actually my first positive experience in a hospital.

On arriving in the Education centre we were taken into a room and taught how to wash our hands. This might sound ridiculous, but with the current scares over hospital acquired infections we can’t be too careful. Each of us is sprayed with a UV dye, and then sent to the toilets to wash it off. I succeed, the woman supervising us seems quite surprised that most of us have managed to get off the vast majority of the dye. Although I’m told that my hands are too dry and I need to buy a moisturiser.. At least I can justify it to myself that it’s necessary..for the good of my patients and all that, and that I’m not just doing it because I’m the type of guy that moisturises his hands..

Finally we moved on to venepuncture (we had a lecture on infection control after the hand washing). There were a few junior doctors in the room who came over to each of our pairs. We had all been assigned an arm. Not a real arm, they’re these fake arms with the correct anatomy (at least of the veins) and plastic that is supposed to have the same resistance as skin. I’ve put a picture of one below for you to have a look at. We were given a choice of needles and told to practice with each as much as we could so that we could make an informed decision as to which we liked the most when the time came to take it from a real person. Having said that, the junior doctor with me and Gareth told us we’d be lucky to find any needles at all on his ward, let alone the choice that we had here. I’m pretty sure I saw him pocketing a few of them to take back up with him, clearly annoyed that the trust was spending money on equipment for students but not for the clinical staff.

venepuncture arm

So, the theory of venepuncture is to find a nice bouncy vein (usually the cephalic or basilic veins in the cubital fossa-the elbow crease). Apparently it’s all to do with the feel of the vein, not what it looks like and not necessarily how well you can see it. You ask the patients permission (Yes, we talk to an arm), explain what’s going to happen and then put a tourniquet on the patients arm. As it’s an exposure prone procedure we have to wear gloves to minimise the risk of infection of both ourselves and the patient. With the gloves on you palpate (fancy medical word for feel)  for a vein that you think you can get blood out of, wipe the area with an alcohol wipe and (without feeling for it again as that would introduce bacteria from the gloves onto the nice sterile site you’ve just created) insert the needle, bevel up at an angle of about 30°. At this point you should see a flash of blood at the top of the needle, to let you know if you’re in the vein or not.

Unsurprisingly, mine didn’t get a flash of blood, which was strange because I thought I was in exactly the right spot. Gareth (a health care assistant in a previous life) and the junior doctor also agreed that I probably should have some blood there, so encouraged me to press the needle a little further.

Still nothing.

So I tried another vein.

Nothing.

Gareth tried.

Nothing.

The junior doctor tried. Twice.

Nothing.

Our bloody arm was broken. There is a little valve at the bottom of the blood bag that nobody had thought to open. So I tried again, doing everything in the correct order and I was rewarded with a vial slowly filling with blood. It was one of the proudest moments of my life. How sad is that? I changed out the vial for another, and another, without moving the needle. I managed to finish up and “dress” the site properly and try a couple of the different needles. Both Gareth and the junior doc complimented me on my technique, so I was positively bouncing when I left the room, with a pocket full of needles and vials to test on some willing victims (one of the members of my group – Ian- volunteered, I think he regretted it later).

So, now in my room is a certificate saying that I can take blood from an arm. It doesn’t qualify me to take it from people yet, but for now I’ll leave that to the junior doctors, vampires and the hybrid..Dr Acula. (see what I did there…?)

I’ve not taken blood from a patient yet, just from other members of my course. It’s easy to take blood from a healthy 23 year old, it’s getting blood from a IV drug user, or a 80 year old with diabetes that will be a challenge. One I am looking forward to.

 

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