Was this unprofessional from the nurses?

[twatmas]

Was in A&E last night / this morning for a horrible SVT run.
My veins are shot to pieces from years of bloods / cannulas / chemo so I know I'm hard to bleed.

Paramedics tried twice in the back of my hands but failed. (No blame there, I'm aware I'm hard to get a line into)
Got to hospital, and a nurse came along. I usually need the ultrasound to get a line in. I was happy for her to try a couple of times before asking for a machine. I did mention to her they usually need the US.

Anyway, after 5 goes in various different places (going over my already swollen sore hands from the paramedics) I started to get restless as it was hurting. I asked her if she could get an US machine as it was now hurting and I don't want to be prodded for the sake of it. She said no, she will keep trying.

6,7,8 goes, I was now bleeding out and my arms and hands were really painful blue. I was crying at this point as my chest was hurting and I was being poked and prodded from every direction. Going over repeatedly battered veins hurts. I said this to her, I apologised for being difficult to bleed but 9 times is too much. The nurse then said 'you've got to be brave, it's only a cannula, what do you want me to do?' And just shrugged.

This comment is what's pissed me off. I don't have a phobia of needles. I have had probably thousands at this point of those bastard things. I've had chemotherapy. I don't need to be brave. I don't need someone poking me 9 times. I need an US machine which could've saved so much time and pain.

I refused to have her try a 10th. A senior nurse came in quite disgruntled that I didn't let the previous nurse try again. He said to me 'well you've been through a lot but we need to get a cannula in.' Well yes, I agree. But not at the expense of battered and bruised arms. He tried for the 10th time, and managed to get the cannula in between my wrist and crook of my arm. Right in the middle of my arm. It fucking hurt, but it was in. I apologised again and thanked them, but they just seemed so annoyed with me.
This is NOT a nurse bashing thread. I have the utmost respect for them, but 10 attempts was horrible and I was made to feel like a wimp.
AIBU? Or is this standard practice?

Nurse here. No it is not standard practice. In my Trust the policy is you can have 2 attempts and if unsuccessful ask a different member of staff to try. If that is unsuccessful sometimes an anaesthetist will do it or a central line will need to be put in if peripheral access is particularly bad.

Ours will try 3 times then someone more experienced is called and will attempt twice more before sending you down to phlebotomy for them to do it. (usually on the first try)

@twatmas ‘'m sorry you went through that. :(

I've got a telephone appointment tomorrow with the arrhythmia clinic for EP study / ablation. Did it work for you?’

It did - transformed my life, it was a long term condition that had been getting more frequent and more serious. It was over 10 years ago and not the slightest hint of it since. Well, I sometimes, rarely, get a couple of ectopic beats or what feels like the very beginning of a run but then it goes nowhere.

Hope your telephone appointment goes well.

I really feel for you. That’s not on at all.

my sister has learning difficulties, she’s also had many many operations in her lifetime. She has notoriously ‘bad’ veins. I tell the nurses this all the time but they always come back with the old “oh I’ll manage” the last time I took my sister in for a suspected DVT, I had to dash out to park the car and when I came back in they had tried so many times to get blood she was crying and wimpering. Despite me telling them they would need the US. They eventually got blood from her foot. Honestly, I dread every time she needs blood taken.

I've had blood tests at the Dr's surgery before where after waiting an hour the nurse has tried 3 times on each arm and still not got the needle in, then asked me to wait another hour for another nurse. I refused and went to hospital instead where they did it instantly and told me it is not my veins, it's the person doing it.

I'm a nurse- it's inappropriate please report. Hospital almost certainly has a policy for two attempts only per clinician that she would have been aware of.

Apologies for the long quote but it’s needed!

Firstly, it’s a fresh needle for each attempt, not let’s save resources embarrassment and give the patient sepsis because the nurse can’t be bothered to go and get fresh needles in case she’s spotted by a senior member of staff and berated for her incompetence!

Secondly, if it looked like she was poking around willy-nilly then she probably was and your arm was so painful by then, that you just couldn’t feel it! And yes, some nurses actually do have the mindset that gritting their teeth and poking around will eventually hit a vein. Because when they practice on oranges, (I kid you not), the poor orange can’t screech (well, can’t be heard to be screeching but probably is, which might be why oranges are so expensive! They’ve all had the memo).

Thirdly, no competent nurse who actually cares about patient outcomes, minds putting their hand up and saying that they can’t do something. I actually had to teach a staff development nurse how to change a PICC dressing when the actual dressings were changed due to funding. No shame or embarrassment about it, if you don’t know/can’t do, then ask! Like when I “taught” a consultant how to properly insert an IDC using a sterile field and ANTT because they literally had the patient standing up and were knelt down about to shove the IDC up the patient’s, well, you get the idea. I was so embarrassed because I had a student with me that day! No gloves, nothing, but there ya go!

Fourthly, next time, insist on a new needle each time, and then after 2 times, insist on talking to the nurse manager. Then request the nurse manager to either get the USS or an anaesthetist down. If the nurse manager tries to give you flannel about urgency or emergency situation, tell them to get a move on then!

Should you require any assistance with drafting an email/letter or would like someone to read over the body of the email/letter (identifying details left out of course), I would be happy too, just send me a PM (if I’m not allowed to offer this, please do delete this post, MN mods).

Clinical skills tutor here. Please report. Two attempts only and always with a new cannula each time

YANBU. that's far too many attempts. I can be difficult to bleed as well, no one has ever had that many attempts. Usually one try in each arm/hand then they will grab a member of staff.

I hope you're feeling better.

@twatmas

if you’re concerned that they may not document correctly, then take pictures of all of your puncture points. You should have had a dressing on top of each needle.

An attempt has to be made with a fresh needle each time, once the needle has been removed from the body. So for example, you might push the needle in and then move it around slightly to find the right point in the vein for flashback - so pushing it in further or retracting it slightly. If the needle is taken fully out it should never be pushed back in! If this happened to you, then even more complain because that is awful infection control practice as well.

Oranges? Since when do nurses practice on oranges these days?

My cannulation course had a set of arm mannequins.

3 attempts in my Trust, if appropriate. Then it’s escalated to someone else more senior. DH has terrible veins and the best person was his chemo nurse.

This is awful practice, please consider complaining.

In my trust three attempts is the maximum by a nurse, but I wouldn’t even attempt that many if you have difficult veins and usually require USS.

Using the same cannula in several different sites is appalling and a big infection risk.
I don’t want to scare you but there’s a young lady who had severe complications from someone using the same needle in different sites. Her name is Amy Pohl, you can find her on IG/YouTube etc.

Exactly - do complain. They should have a system like this - in fact they probably do.

I’m sorry to go against the grain here, but have you considered that she just wanted to get that cannula in and get you treated?
Attending A&E suggests that this was an emergency.
No one enjoys failing to get a line in multiple times and it won’t have been for her own enjoyment.
It’s unlikely that a nurse would use an ultrasound machine, so you would likely have waited a long time for another medical member of staff.
For them to have attended to you, they would have been pulled from another patient.
So you are putting your needs above them?
they DID get a cannula in-yes it was difficult- but they were successful.
The NHS is broken- that nurse was likely doing her best under an insane level of relentless pressure.

Yep, in the dark ages, we used oranges because the arm mannequins would leak if punctured too many times. And the unlucky few that then couldn’t prove their skill on the arm mannequins because they needed to, well, do whatever they needed to do to heal or repair or what have you, just got let loose on the unsuspecting public.

I had to retake all those certifications when I came to where I live now, so I’m even more qualified than a qualified nurse! Which means I should probably be getting paid twice as much 😉

The quickest way to get the OP treated would have been to ask someone else. Bearing in mind she had SVT, the line needed to have been put in asap, so the nurse should have complied with trust policy (you can bet your life that number of attempts went against any trust's policy) and found someone more able to perform the venepuncture.

As for the OP putting her needs above another patient's, nonsense. Trusts have policies in place to ensure that someone else is called after a certain number of failures. It's to provide timely safe care and reduce patient suffering. Nothing to do with anyone putting their needs above someone else's.

I’m a doctor. Complain. On the wards we might not have access to USS, but ED should have it and doctors trained to use it. Most doctors have not been trained to use it so it can’t be hard to find someone who can. A&E doctors usually can do it, particularly if more senior.

Ask them to stop next time. You have the right to refuse treatment. The only caveat is USS machines are very expensive and hospitals don’t have many. It might not have been available, they also might have been worried that you were very sick. If you’re very poorly people will power on getting a line into you if it saves your life.

id speak to hospital about it either way via PALS, hope you feel better soon.

@JoanOfAllTrades

You are so incredibly kind, thank you.
I'm going to write something up this evening after DD is in bed. (I'm home now).

If you don't mind, I'll PM you in the morning. Thank you so much, I really appreciate it.

Due to my heart conditions and cancer history I spend a lot of time in this hospital, so I'd really like to avoid this happening again!

In the hospital where my husband was treated and received chemo, no one nurse could have more than two tries. Then someone else was brought in.

I can understand that it must be tricky when there aren't enough staff in somewhere like A&E, but if you were safe to wait for someone else to be free, that's what should have happened.

I'd let PALS know about this

My mum sadly passed away but spent time with people who could take a line and many who couldn't , I think many need better training.

Whenever you’re ready 😊. Just be aware that it’s almost waking up time here so there’s a bit of a time difference!

I’ve been told I have difficult veins in that they’re tiny like a child’s.

Some people dig and dig but other vein whisperers can do it first time making it look effortless.

What do you mean putting my needs above them? That's precisely the point, I needed the ultrasound machine. I normally have it every other time..

This happens to me all the time it’s like getting blood from a rock. I too often need ultra sounding I find it interesting as a side note to see the holes as veins and those pumping as arteries doc showed me before. However I am quite loud and after five attempts I be like nope not gonna happen and if they won’t listen refuse you can you know. Be stubborn because as you say yes it hurts and no she shouldn’t have spoken to you like that at all they should respect what you are saying.
they have said to me it will be a wait but I am like fine or they get someone else but docs can be worse for cannulas to

On these rare occasions when a medical professional can't find a vein or seems a bit 'stressed', etc, I just say "It'll be ok, don't worry"; reassurance coming from a patient gives them a jolt in a well-meaning way and recognizes our common humanity in the professional/patient relationship.