intro into als

[Kiwiology]

Why shouldnt we lie to them, I mean I quote Houe "All Patients Lie"

Or thier family do, oh yes the unconscious diabetic relative takes his insulin ... and so on

I suppose I've told a few people "oh it'll be OK not to worry" or something like that when I know full well they're pretty crook

[HERBIE1]

Like any skill, starting an IV takes practice. A lot of practice- there's simply no way around that, and simulations can only do so much. Preparation and technique. Have everything you need ready and easily within reach.

I found that working for the privates when I started out, where the vast majority of my patients were elderly, with the tiniest veins imaginable- was great preparation. If you can master getting a patent line on a contracted, squirming, bedridden senior in a nursing home, an IV on a healthy adult is a cake walk.

Key is to use the same basic technique every time. Someone may have veins that look like a city water main, but unless you use proper technique, you can still "blow" the vein.

Experience will teach you that certain patients require extra care- someone who takes prednisone long term will have very fragile veins, making good technique crucial to success. Same with long term diabetics, or someone who may be taking coumadin. Do a little "homework" before you start- check their history, inspect the area- recent attempts may complicate your efforts- or even show you a possible site in a difficult patient.

Ask the patient who has frequent blood draws where the best place to use is- they will know.