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Mind Your Manners

Jeffreywonoprabowo72x722Jeff Wonoprabowo -- Always let the other person go first. That sounds like a very civil thing to do, doesn't it? It sounds like something that one might hear at, say, an etiquette dinner (a dinner organized for the sole purpose of teaching proper etiquette for formal/business situations). It sounds like something a father, hoping his son will grow up to be a fine gentleman, might say to his boy. But when I heard this advice during my first year of medical school, it was not meant to be a civil, polite gesture.

When the upperclassman told me to let the other person go first, he was giving me advice about blood lab. Now, when I wrote about drawing blood last time, I wrote that I had hoped blood lab would only involve finger pricking. I guess that was just wishful thinking. Or maybe selective memory blocking. Regardless, I should have known the blood lab would involve needles because I was told about it over a year before it happened.

The rationale for such advice? If your partner was horrible at drawing blood and  treated you like a pin cushion, you could be sure to return the favor when it was your turn to draw blood. This was, of course, for the sake of education. After all, we should know something about what our patients (or in this case, blood lab partners) have to go through, right?

In my previous post I wrote about my one-try successful blood drawing. I wish it were due to my own skill. But I was lucky to have a partner who was nice and had large veins that were easily visible and fairly superficial. So I take no credit for my success.

When it was my turn, my partner tied the tourniquet around my arm. I told him to go ahead and make it a lot tighter. After tightening it, he proceeded to examine my arm closely around the cubital fossa.

My brown skin mischievously kept the location of my veins a secret, and my partner asked one of the nurses for help. She came over, palpated my arm, and located a suitable vein. After showing him where it was and allowing him to feel it, she left.

I sat there waiting for the sting. The pain came, and I waited. No blood. The needle pressed further. No blood. The needle pulled back without coming out of my arm, changed directions, and again pushed forward.

The needle's under-the-skin directional change was definitely a weird feeling.

Again, no blood appeared in the tube. At this point my partner mercifully pulled the needle out and called for help. The nurse came, relieved him, and drew my blood.

I suppose I got off easy, though. The next day I heard from and of classmates who had to suffer through three or more unsuccessful attempts. One classmate finally had his blood drawn from a vein in the radial side of the wrist because all the attempts in the arm were unsuccessful.

Looking back, I wish my partner could have had the chance to try again. It isn't the most comfortable thing, but we all need to learn how to draw blood. And I wouldn't have minded if he needed to try one or two more times under the guidance of the nurse. And in feeling this way, it seems that I totally ignored the advice I received. I guess I'm just a rebel that way.

October 31, 2008 in Jeff Wonoprabowo | Permalink

Comments

I recently trained as a medical assistant for an undergraduate school health center. Being undergrads ourselves and getting to play with needles was a BIG deal. But all of the practicioners in our office fully understand the meaning of hands-on learning, and we have spent most of our free time with eachother's veins. However, when it comes to patients, not all of us are so lucky. Sick, dehydrated people have difficult, fragile veins! So just practice- and if you can get a lab partner with small or hard to see veins, all the better practice, right? When I missed the first time on a patient with anxiety (and thus a very bad reaction to my first attempt), I was left in the room with her and I was almost in tears that it had been a bad experience for her. I think she felt bad that she had been so nervous and had questioned my experience. I told her that when I'm a doctor, I can tell people I've been doing this since I was 21! It didn't help with the draw, but it reassured myself that all it takes is practice!

Posted by: | Nov 5, 2008 10:16:38 AM

When drawing blood I have found that in patient's who do not have those ideal veins it can be more helpful to palpate for larger, deeper veins. Overall, the best thing you can do is practice and have a confident presence. Don't tell patient's that you are inexperienced or you will add to their apprehension.

Posted by: Forrest Hartford | Nov 5, 2008 7:39:23 PM

I have found that it is definitely easier for both you and the patient if you do not look nervous and/or inexperienced. Be confident and practice and you should be OK.

Posted by: Jonathan | Nov 5, 2008 7:48:53 PM

I work as a medical laboratory technician in the South Pacific and was horrified when I drew blood for the first time. As a student we learnt the theory of it all and the meticulous steps required to successfully draw blood. My practice pin cushion was an orange, and to be faced with a patient that first time, I was mortified. Then I heard the clear voice of my lecturer three years earlier telling me that the patient was first priority and that I should mask my insecurities to ensure the patient was assured of my ability. First try drew blood splendidly. I was releived. The week that followed was tough and often sent me to the nursing station to "get a grip".The skill developed later, so not everyone will pick it up instantly. It takes a little time. I prayed each time I took blood, and I still do, not just for the patient, but for myself as well.

Posted by: Laiyawa | Nov 6, 2008 5:28:45 AM

your experience remains me of mine. The first time I draw blood was in a CP lab, it was my friend's. I did get the blood easily, but I left a pretty big bruise afterwards. Haha :D
Well.. Thank god she didn't get mad.
Now that I have more experience drawing blood from patient, it get easier and easier. And I believe that's what's going to happen to you too! The more you try, the easier it'll be. So just take it easy and try to look as confident as you can, don't let them know you're a newbie, and you'll be fine! :)

ps: wait until your first intubation! drawing blood is nothing compare to that! Good luck jeff!

Posted by: ndit | Nov 6, 2008 11:18:57 AM

Believe it or not, it does get easier. Two years after graduation I can place a 16g cannula in your eyeball if I have to. And yes, there are still days I can't hit the broad side of a barn...they just get fewer and fewer! I still teach nursing staff and students to place cannulas and take blood by letting them use my arm! It's the best way to learn.

Posted by: Jessica C | Nov 15, 2008 2:17:46 PM

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