Everything I Know About IVs

Every so often, I remember that I am reporting on this journey with systemic lupus.  It has been sixteen years, and lately I am experiencing a rapid, unprecedented improvement in all symptoms.  I credit everything:  my B-cell killing therapy, years of mostly vegetarian eating, changes in my state of mind, prayer (mostly from other people)…I’m always supportive of multifactorial responsibility.  These are things I can do now that I couldn’t do six months ago:

1.  Get ready from start to finish and leave my house in 30 minutes.

2.  Stay up until 4 a.m.

3.  Ride my exercise bike at 8 mph speeds for 10 minutes or more.

4.  Take a bath, brush my teeth, and not need to rest afterward.

5.  Hurry from one end of the house to the other.

6.  Go to the mall and other places that require reliable, long distances of walking.

7.  Plan for more than one big activity per day.

8.  Wake up without oral ulcers. 

9.  Schedule appointments in advance and be pretty sure I won’t have to cancel at the last minute.

10. Pick up things that have fallen on the floor immediately, rather than waiting for extra energy.

11. Carry many pounds of groceries up the stairs from my garage into the house.

12. Sit for three hours and not get huge leg swelling.

13.  Taper my prednisone below 10 milligrams daily.  (I am currently at 7 with no symptoms.)

That’s progress!!

A ways back I mentioned that I wanted to do some “Everything I Know” posts.  One aspect of being chronically ill prompts me to start with this one.  When you have an illness that requires frequent blood-drawing (venipuncture) and occasional intravenous  (IV) therapy, the quality of those procedures can drastically improve or negatively impact those experiences.  I knew this from an early age, having started with serious medical problems at age 19.  I was determined to be adept at procedures so that they would not be additional torture for patients who already had to cope with illness or trauma.

 

Everything I Know About IVs I Learned From…

…two incredibly talented, African-American students in the class ahead of me at Jefferson Medical College.  The two guys were friends, and not only were they some of the smartest people I ever met, they were willing to mentor anyone who asked for help.  They were masters of preparation for every medical encounter, from exams to patient care to the competitive, universal, sometimes antagonistic Socratic  teaching in clinical sessions.  These are some of the things I learned:

1.  Read first.  There is something written on every topic you can imagine, and it’s your duty to find good sources and learn from them.  Don’t just rely on what the instructor or professor says or the books they recommend.  Figure out how you learn and find a source that teaches it that way.

2.  Practice, practice, practice, practice, practice…you get the idea.  We used foam pads to stick our needles into at first.  We practiced pushing IV catheters into them and having the catheter end up centered under a single ink line.  We used suture kits and practiced surgical knots until they could be performed without thinking.  It was inexcusable to have your first practice be on a patient. 

3.  Lay out your supplies in advance.  You should have everything within easy reach, keeping sterile things untouched.  You should not require the precious time of a nurse to hand you your supplies. 

4.  You don’t have to make a patient scream with an inhumanely tight tourniquet.  Tourniquets only need to be tight enough to obstruct venous blood flow.  Arterial blood still needs to flow into the limb.

5.  Leave the tourniquet on adequate time for veins to fill.  Unless your patient is a healthy athlete, you can’t get a good idea of possible puncture sites in 30 seconds. 

6.  Look first.  Examine the limb that you’ve tied off, top, bottom, sides, from end to end, so that you don’t miss any visible possibilities.

7.  Feel, feel, feel.  Full veins are palpable under the skin if you use a gentle touch.  This is crucial in darker skinned patients where you may not see the blue of a vein through the skin.  You should develop such sensitivity that you can “feel the red blood cells slipping past your fingertip”.  You can also feel the tough, hardened cord of a vein that is sclerosed and which doesn’t have enough of an opening to thread with an IV. 

8.  Determine the course of your selected vein, and mark it with a pen if necessary.  Your IV will only thread if you hit the vein and push the catheter in the right direction.  Pushing directly against the wall of the vein, instead of into the lumen, results in a punctured vein and big bruise.

9.  Make your puncture swift and sure.  Draaaaaging your needle slowly through the skin is undeserved torture for your patient.  Keep one finger on the vein while you are sticking, so you don’t lose track of your target.

10. Tape neatly but securely.  Your patient should be able to use the limb while the IV is flowing. 

11.  Clean up after yourself.  Anything else is unfair to the nurses. 

All of this sounds very straightforward, but there was one additional element.  My guys insisted that you treat every patient with respect and compassion.  They never entered a room without knocking, introducing themselves, and announcing what they were doing.  When they sat down to start the IV, they would be in conversation with the patient.  Not only were they describing what they were doing and preparing the patient for it, they were chatting and engaging the patient in an experience outside the procedure.

 

Great teachers.  Great friends.  Thanks, guys.

Peace.

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3 Responses

  1. What a great post, I thoroughly enjoyed reading! I was also really happy to read this post. You sound so great in your writing and I hope things will only keep going upwards.

  2. I’m thrilled that you’re able to do so much more now!!!

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