Focus, Focus, Focus!

My lab partner in Phlebotomy yesterday had a lot in common with me; we're both older students, both not interested in having children, both love the outdoors, blah blah blah. We hadn't spoken before that day, and were enjoying the nice warm, fuzzy feeling of a new friend. I drew her blood first, and then sat down for her turn on me. She missed on her first poke.

Not being a needle-phobe, and knowing what a missed poke can do to one's self-confidence, I let her try again on a different vein. As she tied the tourniquet, she was talking away about something or another. She palpated and we decided to go ahead with the poke without loosening the tourniquet.

This isn't unusual, but when one does this, it is important to get the poke over with quickly for a variety of reasons. First of all, circulation is reduced to the affected area, obviously, but also, pressure is building up inside the vein. With my veins, the tourniquet is pretty much a formality - blood leaps out of them, and they're visible at the surface. During the first couple of weeks of class, another partner had tied the tourniquet quite tightly, and then stalled a bit before the poke. As she punctured the vein, blood shot out of the puncture site and burst through the skin at her. It also stung quite a lot, and I ended up with a nice bruise.

So I knew what was coming.

This week's partner was a little flustered from having missed the first time, and was not in any hurry to do it again, despite the tourniquet. I said supportive things to calm her and so forth, all the while wondering about the blood accumulating in my basillic vein. Several minutes had passed.

I thought about saying something about what was going to happen, but I wondered if the experience of seeing what happened would have a greater impact on her than me simply telling her. I decided to take one for the team, and just let it happen.

I would say 4-5 minutes passed from the time she applied the tourniquet to the time she poked me. It stung pretty viciously when she poked, and then, to make matters worse, she backed out of my skin! She pulled the needle right out! And THEN, she stuck it back in! By the time she was going back for the second poke, blood had already spurted out rather impressively, and her teeth just about fell out of her head from surprise. "It's ok, it's alright, just grab the cotton ball," I said calmly, "I'm ok."

From across the room, the lab instructor raised an eyebrow at me, looking askance. I shook my head slightly and started talking my partner through what had just happened, Needless to say, she felt awful, and I thought having the instructor take her to task for it would only make her feel worse. I applied sustained heavy pressure to minimize bruising and then gave her one more chance on the other arm. She got blood, and she didn't dawdle after applying the tourniquet, either. "I'll never forget that again," she said, wide-eyed.

Sometimes, you have to touch the hot stove in order to fully grasp what "hot stove" means. Had I told her, "oh, hey - the tourniquet's been on a bit too long, and here's what'll happen," she might not have taken it fully to heart.

Which is NOT to say that you should run around letting people screw up medical procedures on you! My point here is that we have to keep focused and not let our attention wander during procedures. Give the patient the respect of focusing on the task at hand, and performing it correctly.

There can be some pressure to make small-talk, but don't do so at the expense of your patient's well-being. We can all think of ways to politely deflect chit-chat, and sometimes it's necessary to do so. This isn't the hair salon - we're doing procedures, collecting samples and giving treatment that can potentially mean the difference between life and death.