So yeah, I have to admit it. I am kick ass when it comes to starting IVs. I've been doing this job now for a year and a half and can honestly say I have mastered this skill. You probably won't find a person that is better than I am this, and I'm not just saying that. My job is cake...most of the time.
Yesterday, I received a page to go to the hospice unit. No big deal. I've been there plenty of times and experienced the sadness that looms over the entire floor. The patient's name sounded really familiar, but I couldn't put a face with the name until I walked into her room. Which by the way had her "code status" posted on the door, which included oxygen, IV fluids, and CPR. Nothing else.
This patient is incredibly sick. She has cancer of some kind...I think she had previously mentioned that it was liver and kidney cancer. In addition to this, she is a dialysis patient so she only has one arm available for IVs because of her fistula (equipment used to dialyze patients). She has been in the hospital for almost a month, so try to imagine what one arm being stuck for labs and IVs looks like after a month of torture.
Anyhow, I walked into the room and her face lit up. She was so happy to see me and told me she was relieved because I was the one starting her IV. (Keep in mind, I've started probably five or so on her during her stay at the hospital). She seemed to be in generally good spirits. She was reading her Bible (as she always is) and had a couple of visitors in the room.
I stuck her the first time in the biggest vein that I could find, which was not big by any sense of the word. It didn't work: the vein blew. I looked around her arm some more and thought I would try something else. A smaller gauge needle I thought would surely do the trick.
I found the nurse, and requested a 24g needle. We had to have one sent over from the pediatric unit because 24gs are generally only used on infants, premies, and newborns. I waited around until the supplies came, talking to my patient. When it finally arrived, I found another vein, stuck it...and again....no luck. It blew.
The only other trick I had up my sleeve was to try starting the IV without using a tourniquet. This works sometimes in older patients because there is no outside pressure on the vein. Outside pressure from a tourniquet can make veins blow if the they are fragile from age, overuse, or certain drugs. My patient had all of these things stacked against her.
So, she was happy to let me stick her one more time. However, no luck. Same situation with the vein blowing. She burst into tears and was hopeless. She knew that "if I couldn't do it, then no one could."
I cannot express to you how devastated I was. I felt like a complete failure at my job. I know that it's impossible to successfully obtain an IV on everyone, especially patients like this. It's just that this particular patient has a special place in my heart, as all cancer patients do. I really wanted to help her...and I couldn't.
I apologized to her and left the room, crying.
Sometimes health care is just overwhelming. Most of the time (like 99% of it) I can keep my emotions together and move on. And there were other options for this lady, but she had so much faith in me and I let her down. Some days, my job just sucks.
And when you finally do achieve some awesome calluses, people are going to notice (or at least they better):
And when you finally do achieve some awesome calluses, people are going to notice (or at least they better):
