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?

I do this too, all the time. But not by the time I'm on my 5th or 6th, I start to get the cob on then if they don't get someone else to try, or use the machine.

I think many of us do that but let me tell you after somebody that’s been regularly in hospital with cannulas because I suffer from a lot of cellulitis with lymphoedema I will tell you that starts to wear a little thin when they’re on about the fifth time in a few minutes

Most likely there was no US machine available, or nobody who has been trained to us it. That should have been explained though.

We have one on our ward, but not in our outpatient clinics. And none of our nurses and very few of our junior doctors are trained in how to use it (to be fair, our nurses don’t do cannulas). Means all difficult cannulations are done by the SpR.

@Knockon same in my Trust I think. Don't know the exact protocol because I'm not clinical, but I have also been in for a similar problem and also have difficult veins, and was told that if they couldn't manage to get a line in they would have to call a phlebotomist to do it. They definitely can only have a certain number of tries before escalating.

I don’t get blood tests regularly and most of the time, they can find an injection site easily. However there has been a couple of times where they couldn’t find one quickly, they only attempted to jab me once or twice and moved on to a different person or injection site if there was no luck.

I can’t imagine why they would keep going 10 times, especially for someone with a history of needing care to take blood from

YANBU I haven't been through what you have and I would not want someone taking 10 attempts! Really poor on her side to think that's at all acceptable.

This happens a lot to OH who is like a pin cushion due to needing weekly blood tests, monthly infusions, for his long term cancer treatment.

He's had to learn to be assertive with those taking bloods. He won't let anyone have more than 2 attempts and insists on someone different. He always warns them in advance that he's got ongoing problems with them trying to take bloods, tells them where he wants them to take it from, etc. Most are really good, take on board what he tells them, and give up themselves after 2 attempts without him having to tell them to stop. But occasionally, he gets stroppy/awkward/arrogant ones who think they know best, insist on doing it a different way to what he tells them, and try to go on and on getting nowhere - when that happens, he is assertive and tells them to stop and get someone else. They don't like it, lots of huffing and puffing, but ultimately, someone else comes and does it (where and how he tells them to!).

FWIW, the ultrasound doesn’t always help achieve cannulation - it can be useful for showing where a vein is/getting a needle in it, but doesn’t necessarily make it easier to get the cannula in it. For peripheral cannulas I tend to only use US on people with bad peripheral oedema whose skin isn’t loose.

A few other thoughts based on other posters’ comments….There are some limitations to size/site of cannulation depending on the reason for needing it and drugs that need to go through it. PP referred to wanting a cannula for adenosine in their hand - this is not usually the first site we’d try - the closer to the heart the better for that particular drug. Some other drugs need to go in big veins because they’re so irritant. However it’s often better for less irritant drugs/in a less urgent scenario to start distal (ie in the hand) and work proximal because antecubital fossa cannulas often don’t work that well if someone starts bending their arm. The number of goes an individual should have depends a bit on the urgency of the scenario, the availability of another suitable person to make an attempt and the risk vs benefit of the alternative I’ve access options (inc central or intraosseous access) - am pretty sure I’ve tried 10 or so times in the past and it’s been completely appropriate. The appropriate size of the cannula also depends to some extent on the reason for the difficulty - where cannulation is difficult because of oedema/obesity putting a 22G/20G (blue/pink) cannula in is fairly useless because they’re not long enough.

There isn’t always an anaesthetist available immediately so insisting on an anaesthetist doing it is often only going to reduce your chance of getting the treatment you need when there are usually plenty of other people in the hospital who can do the job.

there does seem to be a fashion for teaching a properly cack-handed (2 handed) technique for cannulation the the last few years. It works very well on mannequins but is utterly useless on real people with anything less than hose-pipe veins. It often takes a while to unlearn that technique!

So much wrong with this post.
The rule of 2 per staff member is pretty universal. All nurses want to get their patients treated. Why should this particular nurse be keener to treat than any other and why do the rules not apply to her?
How do you know the op would have waited a long time?
Of course the op is not putting her needs ahead of some other hypothetical person. That is a ridiculous thing to say.
They got a cannula in this time yes, but the op is in pain, at higher risk of complications, and it will be that much more difficult next time (which is why they have rules about number of attempts).
And yes the NHS is broken but individual patients should not just submit to substandard care otherwise things will not improve.

Ok - thankfully it's been some time for me since I had to be hospitalized/A&E/blue-lighted - so I accept what other posters are saying as their experience now; things have changed in the past 20 years.

I'm not sure 'overwork' is particularly new, saw plenty over the years. The main difference has been the massive increase and reliance on technical diagnostics. Even temperature and blood pressure requires some digital (hugely expensive) piece of equipment rather than a watch and some fingers.

Scans of any time were the exception, rather than the rule, now they are expected and demanded beyond any routine examinations.

Still, I will still reassure any healthcare professionals that treat me, it's part of the trust between us.

I’m a nurse and that is appalling. In our trust and believe many others, only 2 attempts by the same person. Why didn’t they get the US to guide them is beyond me. I would def complain.

Just to add that I'm not criticizing either HCPs nor Patients, just the unrealistic expectations, monitored by and forced by costly tech, that have been set for all.

YANBU

My daughter was 7 , needed one. I don't know how many tries. There was blood all over the floor. Then they put a pillow down to soak up the blood (all whilst shielding her with a 'Wheres Wally' book).

She gave in a cried too.

The same with my son many years ago. Tried and tried before he went into theatre. Ended up gassing him and using a vein in his foot.

Incidentally, it was the junior doctors that were shit in both cases. The nurse came along and put one in for my daughter like she did it every day (she does!) Daughter's hand was green, black and blue for weeks.

You can only reassure and be kind for so long. My late husband used to find it really distressing when his chemo nurses couldn't get a vein.

If you're in an emergency or otherwise particularly stressful situation as a patient, the pain and the stress is a whole different ball game, and the nurse's pride is not the priority.

This 100% is the usual rule

I've never ever ever had a nurse use a different needle when they've failed to cannulate the first time, and I've had lots of cannulas. Is this a thing?!

So why is this happening now is what I want to know. Too many posters here describing their awful experiences of trained HCPs unable to take blood.

I would really like to hear some reasons why this very basic and core healthcare procedure is proving to be so difficult; surely it can't be due to a massive collapse of the UK population's veins?

Oh OP I'm a nurse and this is awful to read. Appalling treatment. Please do put a complaint in.

I try twice then get someone else in. And with your history, even though I am quite good, I would get someone more experienced to come and cannulate you - with the flipping US machine.

I hope you're ok. And again, I'm sorry you've gone through this.

I’m a nurse and they are bang out of order. 3 times max and then seek someone more senior/vascular access team if they have one. Or use the uss. Hope you are ok xx

Took 15 goes to get a cannula in me a few months ago and it was agony. In future I will ask for an ultrasound.

I've never seen 10 attempts from one person in my 20 year nursing career. It's not allowed in the hospital I work, no way.

It shouldn’t be assumed that the nurse was of course an angel who ‘was doing her best’. There are a lot of lovely nurses, but also some who are not so lovely, and people shouldn’t be encouraged to not challenge them if they feel they’re not being treated properly.

I feel sad about how you were treated. YANBU.

In my trust it’s a total of 5 attempts 2/3 between 2 people before vascular access is called. I’d write to PALS

10 wasted needles like the NHS has money to throw away like that! YANBU