Denizens of Pandora had customized USB ports attached to their manes for healing; while we humble mortals have to make do with IV access! Cannule of various sizes and gauge, color and type fill up our workstations. Through our training period, judging vein caliber, we answer the eternal question… will this canula fit?!
Each of us would have had our moments with the cannula, be it pleasant or not and no I don’t mean the patient! Well lets face it,not all patients are engineering students from ICE to extend their hands and say.."jahhpanah,tussi great ho!! tohfa kabool karo!! Poking a needle into the limb of a limp guy may look like voodoo science for laymen but throw in asepsis, a cannula of the right caliber and a vein of the right length and we have an important event called IV cannulation!
As a fresher, the first impression of IV cannulation was that it was a back breaking job! No one bothered to tell me that u can do cannulation sitting down beside the patient. Given the abject ignorance to spinal problems that the ward beds were designed with, bending forward and precariously perching my head on a bent back ever so slightly to get that perfect position for the perfect vein cannulation was a talent well practiced. Throw in fancy clothes and I could have passed as a trapeze artist! Back breaking labor with a needle and syringe yielded multitude of blood samples which had to be processed by the lab. Reports of ‘sample clotted’ ,’hemolysed sample’,’ quantity not sufficient’, ’wrong vial,you moron!’ revved up my dull drag of an emergency duty.
Eventual awareness enlightening me, life seemed daft till I got into anaesthesia. Arterial lines, Central lines, Transducers and the kind decked up my list of things to do. The first thing they tell you is that they are all blind techniques. Oh yeah, try doing it with your eyes closed, I say. You could manage to cannulate your own radial artery or a vein while at it, now, couldn’t u? Eyes closed for self cannulation!! We could post a new article in the journals now..New techniques in anesthesia, eyes closed to better cannulation!
Getting a case done with an arterial line or a central venous line insitu , augers well specially in a gynae case where the gynecologist stumbles on a bleed which was long forgotten to send the patient into shock. Persistent requests for repeat samples for cross matching can be heeded to with ease. How they manage to lose samples only to find them later is a mystery given the litres and litres of blood products that the blood bank spews out if it’s a obs gynae patient!
Damping under or over is not just limited to physics, my friend. Thread in an intra arterial and your senior will quiz you on the intricate wave form analysis that your mere act led into. Failure at securing vascular access is a nightmare for an anesthetist. Veins look so tortuous or spiral or designer fresh to the tired eyes. We are blessed with so many challenges of the miniature kind…The stilette goes in, cannula doesn’t; itsy bitsy valve resting just at the tip of your canula; miniscule clot occluding the canula; ripe red tomato appearing at your injection site to tell you…dude.. Counter! When u pat yourself saying, ”aal is well”, manage to thread in a canula ever so perfectly only to find out the drip isn’t running reminds us of a hacker’s job! The jargon “ACCESS DENIED!” flashing in bright brilliant red when you contrive to get past it. And I haven’t mentioned the unenviable job of finding an iv access in a patient in shock, after cancer therapy, after the emergency docs tattoo the patient with failed attempts and the kind, yet.
Till god almighty picks a leaf out of James Cameron’s book to put in a USB port on all of us, here is me signing off.. Well, we all have IV cannulations pending now, don’t we?!
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