Any anaesthetists on here?

[axillarytailofspence]

AIBU for expecting to be successfully cannulated for a hospital procedure? Attended on two occasions. They have been unable to get a cannula in. My arms have been bruised badly both times after numerous failed attempts. I go back in a month. What are the options open to them/me? I know my veins are the problem - I am not bashing the staff. I just wonder what else they can do.

There are loads of places they can stick a canula, doesn't have to get your arm.

Make sure you're well hydrated as well next time.

(Not an anaesthetist)

Ultrasound guided, should be no problem then.

I always have issues with getting canulas in. In the past they've used ultrasound guided or taken me to theatre and put a picc line in. Twice following surgery I've had a central line put in knowing I'm going to need intravenous access for a week or so they decided that this was best.

Are your veins always awful or are they only awful when you are fasted (dehydrated) in a cold theatre suite wearing a thin cotton gown?! Mine are ok normally but vanish when fasted and cold. Heat packs can make a big difference (one day surgery unit I go to has these to hand out or you could take your own) but as above anaesthetists should have access to ultrasound to do it ultrasound assisted. Good luck!

Yes, there should be someone who can use the ultrasound. When I was in hospital after a major accident a few years ago all my visible veins got used up but they managed to find more with ultrasound. Also I had to get a bit stroppy and insist that they didn't let junior people stab me multiple times before calling for help as that just spoiled veins that someone more experienced might manage. I didn't make myself popular with the nurses but it's what one of the anaestgetic consultants told me to do, so I did!

@axillarytailofspence Have they said why it is so difficult? Anaesthetist here - can only remember a couple of patients where it has been almost impossible and we have either had to put in a central line (a line into a bigger vein) awake or use the gas to put someone to sleep and then find a vein after (which isn’t always appropriate). We are the ones others call when they have an issue so unusual for us to not be able to but it does happen.

Anaesthetists can use ultrasound as others have said but sometimes it is still really difficult even using that!

I had issues a few times. I suggested they use my feet, as we would in children. But they wouldn't. I was sitting on a chair for a short infusion. So didn't need to mobilise, I could t see the issue!

Ultrasound helps in most cases, or trying different locations- hands, feet, even neck is used in some cases.

Ask for someone senior to do it, it's not rude to say that more experienced staff will do it better.

Have they advised you to keep warm, keep moving (if you're able) and drink plenty? The only way my veins behave is if I keep a hot water bottle on my arm before appointments.

[quote countbackfromten]@axillarytailofspence Have they said why it is so difficult? Anaesthetist here - can only remember a couple of patients where it has been almost impossible and we have either had to put in a central line (a line into a bigger vein) awake or use the gas to put someone to sleep and then find a vein after (which isn’t always appropriate). We are the ones others call when they have an issue so unusual for us to not be able to but it does happen.[/quote]
I think the problem is that a lot of staff can be dismissive if you say your veins aren’t good so you go through the whole rigmarole every time (and I speak as an ex-HCP).

I’ve worked with paediatric anaesthetists who are obviously the bees’ knees at cannulation, if a parent explained previous problems with their child then we would try to arrange in advance for an anaesthetist to be around to cannulate. I think children’s hospitals tend to be a bit more flexible then adult ones though.

I’m not an anesthetist. I am, however, possibly the person with the worst veins in the world. (No joke - I have a disease that attacks my veins; I have to go to a certain lab, they must see 50 people per day, I went after a year, and they STILL remembered me as the most difficult person ever. And I get that a lot. I woke up after my last surgery absolutely COVERED in cannulas - both wrists, neck, everywhere, one even sewn in - as they couldn’t have them keep failing).

So, what do you do??

1. Hydrate as much as possible. This can be difficult if you have to start fasting before a procedure but check with them when you have to stop drinking water (some will still allow you to drink water for longer, just no solid food). And drink tons and TONS for the four days before.

1. Before they even start, tell them FIRMLY you have bad veins and they need to really search and may (probably/definitely) need ultrasound. Don’t be meek, don’t tell them it doesn’t hurt if it does, and don’t let them turn you into a pin cushion. If they need to search for a vein for 30 minutes BEFORE they put a needle in, so be it. Better than failing.

1. Do not let them brush you off about having bad veins at the beginning. This can lead to screwing up a possible “good vein” you have because they let a less experienced person try to cannulate you when you have very difficult veins. Tell them from the start that cannulation has failed twice and it MUST work this time so they need to really search for a vein, ultrasound, get their best vein person, before even starting.

1. As you’ve seen from 2 and 3, advocate, advocate, advocate. You must speak up. You must tell them everything from the beginning. And remember, a failed cannula isn’t your fault. You didn’t ask for shite veins. None of us do. But I’m equally surprised they didn’t use ultrasound on you the second time. I usually say it’s not the fault of the person doing the cannula either, but it does start to be if they’re not using every resource.

They can cannulate anywhere, we do in Paeds at least. I’ve found chemo nurses are amazing at cannulating. Anaesthetists are usually good as they’re the people we call when no one else can.

Some people (myself included) have tricky veins. I often end up cannulating myself and doing my own blood samples.

Don't be shy to tell people you have tricky veins. It can help if you know exactly how tricky certain sites are - do you have places where a skilled person can get a pink or a blue needle/cannula in? are there veins which look good but collapse straight away? are there sites that conversely look iffy but have decent veins underneath? If you can tell people these things it can cut down on failed attempts. If you need ultrasound guidance then it's helpful to let people know in advance so that a) the equipment and b) someone who can use the equipment can be available.

Ask for someone else if the person trying is struggling, but be aware that skill with cannulating and taking blood doesn't necessarily match with someone's professional status. One of the best people in our team for taking tricky bloods is one of our clinical support assistants, and if I can't get a sample from someone I'll ask if he can.

Sometimes it does take a lot of tries, unfortunately. Tell people if it hurts and/or you need a break, and ask for topical analgesic/anaesthetic gel if needed (some people find it helpful). Staying hydrated helps, as does putting your hands in warm water to increase dilation of the blood vessels there.

I have similar problems to you, op.
Was in hospital recently to have my gall bladder removed. Four different people had a go at canulating me, eventually they managed to get one most of the way in, but it was a bit dodgy.
Went in for my surgery and the anaesthetist told me they'd manage and would probably put a new one in whilst I was out.
When I woke up I had one in each hand but my left forearm had a huge bruise on it where they'd tried and failed. I've never seen a bruise like it. I'm three weeks past my surgery now and it is fading, but there's a long hard lump there so I think the vein is wrecked.
Pp is right, you do need to speak up for yourself.

After about the 8th or 9th attempt they call the anaesthesiologist’s down, or if I’m having surgery they wait till the last bloody minute.

I normally end up with one in my neck or near my foot. I do say now go for the neck to save me some pain but they don’t always listen to me

I’ve found that the paramedics aren’t too bad at doing it but they use the tiny needles then a&e either leave it in or butcher me 🤷‍♀️

The nurse at the doctors can’t get a blood sample and I ended up at hospital for one which defeats the point of going to them.

I was never easy to cannulate, but now have one arm that can't be touched, had all the veins in the other hand blown, and just really hard to use other veins. My last surgery they had to put me to sleep with gas and then do it as the anaesthetist couldn't get anything and it was all getting rather unpleasant.
I super hydrate, keep really warm (coat and hand warmer) and then say I am really hard, that my veins are fragile and often they will go back through the wall, and don't take any nonsense about 'having a try' as I will be massively bruised anyway
If its in hospital, ask if they have an arm warmer as they are supposed to really help, as does using ultrasound or the IR vein finders

Another anaesthetist here. Some people genuinely are extremely difficult to cannulate. Ultrasound sometimes helps, but not always - depends what the problem is (I rarely use it first line). If peripheral cannulation is impossible then central access (either in the neck or top of the leg) are options - both come with different risks to peripheral access so they’re not usually the first choice of technique. If it’s for something like chemotherapy then it may be that a tunnelled central line or similar may be appropriate (often sited by radiologists). Lots of hospitals have vascular access teams now who may be able to help.

In a crashing emergency intraosseous needles are sometimes used. In the peri-operative context a gas induction rather than iv may be safe.

Anaesthetists are usually happy to help with iv access outside theatres when we can, but it’s usually an informal set up and when there’s theatre work to be done it isn’t always possible to help straight away. You can always decline further attempts if you’ve had enough - it is pretty miserable for people with elusive veins - but that may mean not getting whatever drug/investigation needs doing and having to work out another plan with your consultant/GP.

Hi, many thanks to you all.

Apparently my veins are very tiny. I've done all the hydration/warmth stuff to no avail. Apparently the ct angio with dye means they can't use my feet for access or small gauge needles. Also I've always been difficult to bleed/cannulate but more so since sepsis a couple of years ago. Had a picc line for 4 months then. I will ask them to try the ultrasound machine next time, etc. I wouldn't mind so much if it wasn't a 4 hour round trip to the hospital.