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To think that four hours was too long

(89 Posts)
pamplem0usse Sat 09-Feb-13 23:49:24

My 4.5 mo DS needed a medical procedure on fri that required a cannula.
Four doctors attempted for two hours before calling an aneasthetist to have a go. He tried for another hour and a half and failed. There are at least fourteen puncture wounds in his neck alone, each representing several attempts.
I eventually called a halt to it as he'd not been allowed milk for five hours and the procedure would have taken another hour. He wasn't given any form of aneasthetic. They want me to go in for another try next week. would i be being unreasonable to insist we have it done elsewhere?

pookamoo Mon 11-Feb-13 10:14:31

My 5 week old DD2 had to have blood taken, and as the nurses held her down and she screamed they said "it doesn't hurt her, she just doesn't like being held down" Like fuck she doesn't. angry

I think you should definitely be speaking to PALS and getting your GP to see if they can refer you somewhere else.

Huge hugs to you and DS.

SilverSixpence Sun 10-Feb-13 19:53:25

Yanbu, I have been in the position of having to put cannulas in babies and would certainly not have tried more than 3 times myself before calling someone more senior. It's v v distressing (can be for the doctor too!). If its medically essential then I can see why the anaesthetist was called but if they had tried for so long then ywnbu to ask them to stop.

MorganLeFey Sun 10-Feb-13 19:30:00

Please let me know where casualty nurses superhumanly cannulate paediatric (especially infant) patients & I'll direct all my Paeds junior doctor friends there for locums! smile

Neonatology ANP's on the otherhand - can be pretty damn good although perhaps it's not a fair like for like comparison to pit them against a rotating junior doctor in neonates. Although when they don't get it the escalation is then back to a doctor to try so those rotating juniors who are going to be the Paeds/Neonatal/Anaes SpR then Consultant some day do need to gain experience. Sometimes doctors are rubbish at 'easy' ones because they only ever get called to do the weird & wonderful - after care of the elderly/paediatric jobs it took me a while to get back into the swing of big man/women in labour veins!

Don't think any hospital I've worked in has had a 'policy' on how many times one HCP should try - I think it's situation dependent on why they're failing, if there are still veins to be tried & the urgency of the situation/availability of senior support. 2-3 attempts (WITH patient / parent agreement) would generally be my max though & sometimes I've escalated after 1 if there's nowhere else to be seen - resulting in some of the anaethetist with ultrasound machine/going to theatre scenarios.

willesden Sun 10-Feb-13 18:56:56

In my experience, nurses are a thousand times better at finding veins than doctors. A casualty nurse would have done it in seconds. Does like too many egos at work here. Poor little baby.

That's awful. Dd was in hosp at 12 days and had to have one put in her arm. Doc struggled a bit and next time a nurse did it no probs, dd didn't even wake up. With the doc she had to be held down and by the time it was over she couldn't even cry anymore she just mewed and shook. It was the most horrendous thing I've ever gone through. My dh had to hold her down while I sobbed like a loon.

ScillyCow Sun 10-Feb-13 18:15:22

I stopped the Junior DOc after 4 attempts with DS when he was 14 months old.

The next doc who came managed it first time. I feel like I got off very lightly after reading all these stories
sad

soverytiredofthis Sun 10-Feb-13 18:11:27

sometimes only the Doc's from neonatal unit can deal with chubby limbs. We had this several times with DD when she was 4 months old.

Insist on a Doc from this unit being called next time they fail. our hospital has a 2 strikes and your out system. They then have to call another Doc.

FutTheShuckUp Sun 10-Feb-13 18:05:14

Exactly Morgan. Was going to argue that but cba with being told I didn't know what I was on about. It can be hard enough to cannulate a child with good veins let alone a flat dehydrated baby.

MorganLeFey Sun 10-Feb-13 17:49:40

SandCastlesGoSquash = My DS was 10 weeks premature, and changing the cannula in his hand never took more than 3 goes, and that is with tiny premature veins. They are incompetent...

No. It's a skill done by people not robots & sometimes, unfortunately, is just difficult - merely being unable to site any cannula does not make them incompetent.
Sometimes departments have an infra-red type light that can help show impossible to feel veins up through limbs but once they're bruised it's harder to use.
& as people have said in emergency situations there is the Plan B option of intraosseous (through bone rather than vein) access for resuscitation.

Even in grown people I've come across scenarios where even anaesthetists using an ultrasound machines to try to find veins can't get baby sized drips into them (so it's not about junior doctors just being rubbish - sure some are but they don't usually let them try on children!) so you have to go to plan Bs of putting them into neck veins or arteries or longer lines using other methods of imaging to guide in theatre or the bone thing in adults too in an emergency.

What you could say is incompetent or unprofessional is how it's responded too though... & if it's not an emergency & parent & child are distressed you obviously need to communicate & think of a Plan B - which may be taking a break (for both parties & some parents preferred child to go with a nurse instead of them) / alternative distraction/numbing strategies depending on age or rescheduling. In hospitals I've worked there's no way we'd try that long in one session - although missing the investigation slot would also be a time limiting factor too!

I know exactly how you are feeling.

Dd who is 16 months old had to have a blood test 2 weeks ago, I had to ask them to stop after 7 attempts!

2 person tried including the registrar, he even tried to get a vein where no numbing cream was applied hmm

Even though I asked them to stop, he was asking me to let him try again which I refused.

We rebooked the appointment and the 2nd time they had someone to distract her and they managed it on the 1st attempt (it wasn't without any tears though).

The bruises on her hands from the 1st attempt are only just fading away.

Ask them to stop if you don't feel comfortable with them carrying on!

SandCastlesGoSquash Sun 10-Feb-13 14:25:06

It should not take that long. My DS was 10 weeks premature, and changing the cannula in his hand never took more than 3 goes, and that is with tiny premature veins. They are incompetent, I would go to a different hospital, and write a complaint to the original hospital. if it takes more than 3 goes for someone next time, ask if someone else can try. Poor you and poor DS sad

dorapeppageorgenoddy Sun 10-Feb-13 13:28:05

Don't go back get the referral either to GOSH or another hospital with dedicated children's section - lots of hospitals have dedicated children's a and e, could a visit there speed up a referral if he is poorly? Who on Monday go to GP and explain and insist on a plan, phone Hv to explain the situation -

My little one 17 months at the time became very ill while in hospital and had to be held down to get the cannula in, they asked me to leave in the end cause he had to have it and it was horrid watching his eyes look at me, like why are you letting them do this - but it was 20 mins or so when they managed to get one in, they tried once more as he did need two but the consultant called it off and said let's let him calm down and can assess later - But what made it ok in this situation was I knew he needed it as he was in HDU and the drip was the next stage to get the right medicine in - it must have been very upsetting for you in a non emergency with such a young baby -

Draft a letter and talk about the experience with loved ones just to air it so you start to feel better -

I'm no sure of the medical history but hope you are ok and your baby gets answers soon -

HugAndRoll Sun 10-Feb-13 13:14:57

He's home but still poorly. Can't keep food or milk down still only juice. He's vomited every day since last Sunday. He's lost 2lbs already sad. He has severe rotavirus and I was told it could linger but I don't know when to worry about not keeping food or milk down, he can't live off juice only long term (although that's an improvement and has only been since Friday).

I think you should complain OP, that sounds awful.you don't need to put in a formal complaint if you don't wish to. Have a chat with the PALS team and push for the referral to G.O.S.

Hop your DS is OK Hug?

FutTheShuckUp Sun 10-Feb-13 13:02:34

You would think after all the medical advances we have seen over the past twenty years at least they would have come up with an easier way to cannulate babies!!

Teapot13 Sun 10-Feb-13 13:00:38

I don't think they can use numbing cream on under 1's. They sometimes try it but it causes reactions that make it harder to see the veins.

I know from experience with DD that it can extremely difficult to get a vein in a small baby -- even for an experienced, competent person -- but 4 hours is way out of order. I would definitely complain and demand a new plan when they try again.

FutTheShuckUp Sun 10-Feb-13 13:00:12

It is recommended in an emergency as the second choice of access if venous access isn't possible as stated in the Resuscitation Council Guidelines

HugAndRoll Sun 10-Feb-13 12:59:51

Sorry to hijack your thread op.

HugAndRoll Sun 10-Feb-13 12:58:47

pobble that response was for me as that was a very real solution on Monday for my ds. For him it was 17th time lucky for normal cannulation but it was literally a case of he HAD to have IV fluid and antibiotics or I may not have brought him home on Friday.

I thought it was obvious that Fut was answering this, What is the other thing they do in an emergency? I ask because on Monday (the day my baby had 17 needles for 1 successful cannula) I was informed that if they couldn't get a vein they would have to do something else which is "not very nice"

Intraosseous is taught as a likely way to give fluid to an infant in a resus situation on the PILS.

FutTheShuckUp Sun 10-Feb-13 12:48:35

What would your 'solution' be though? Bearing in mind the time implications and infection risk of a CVC for an acute emergency?

FutTheShuckUp Sun 10-Feb-13 12:46:20

You dont think its a solution when a child needs fluid resus and going to theatre for a CVC would cause considerable delay?

FutTheShuckUp Sun 10-Feb-13 12:45:18

Ouch viva what a weirdo! The noise it makes when its sited is bad enough to put me off!

Pobblewhohasnotoes Sun 10-Feb-13 12:44:33

And as a qualified paeds nurse I do have a some idea about access in emergency situations...

Yup and I'm a qualified paeds nurse too, and don't think it's a solution.

VivaLeBeaver Sun 10-Feb-13 12:43:31

Intraosseous access sounds a bit horrific but I'm assured by a colleague its no more painful than ordinary cannulation. He used one of the "bone guns" on himself to see what it felt like and said it was fine.

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