A year at U of R

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Friday, August 04, 2006

Subclavian line or lunch?

I continued to be amazed by how involved I am already (on my sixth day of clinicals). Today was a busy day to say the least. I was on my feet from 7am to 3pm, with about a 15 minute lunch to sit down. Normally, I'd join everyone down in the cafeteria for a 45 minute lunch. Today, I took a short lunch to watch a subclavian line that was being inserted into a client's vein. Yesterday I took a short lunch to attend an epilepsy group meeting that is evaluating patients who are monitored in rooms 24/7 for up to 10 days while they deprive them of food, sleep, and submit them to strobe lights to try to induce a seizure. But more on that later.

Inserting the subclavian line sounds like a lot of drama. The doctors donned sterile gowns, gloves and caps, and there is some blood spurting. They use a needle and syringe initially to go underneath the clavicle to get to the subclavian vein. They know they have hit the vein when the syringe easily fills with blood. They then remove the syringe, and they put a guide wire through the needle into the vein. Then a plastic spreader and the actual line (a plastic tube), go onto the guide wire.

I stood by and tried not to get in the way. Occasionally I fetched some supplies that were needed, or helped re-attach an MD's gown. I talked to the client, and tried to give the client a hand-massage to keep the hand out of the sterile field. The MD's were particularly worried about this, because the sterile field was essentially the patient's entire draped body. So I held the patient's hand, and chatted when I could.

I would not want these doctor's jobs, though. Two of them spent about an hour and a half stabbing away, trying to insert the line. Finally, they called in another physician, who also couldn't get the line in. He then tried for the jugular vein, but was unsuccessful there as well. It wasn't exactly made-for-TV drama. Just lots of uncomfortable poking. Still, I found it fascinating to watch. It was the first bloody procedure I'd seen. I was a little worried that I wouldn't be able to handle blood, but it wasn't a problem. I was mopping up clots from the client's hand, thinking about how hungry I was for lunch.