stories 2 - from m - swiss cheese night

from m...

Last night, my team was on call, so we cover the other teams' patients till the night [float] team arrives.

One hour before we were supposed to "sign out" [to go home], i get a page about a lady who lost her IV access and will need one for pain medications and a blood transfusion later that night...all the floor nurses tried and could not get it so the on call team was called.

So I figure.....an easy IV line, no problem. Off I go to meet a cachectic long-term IV drug using lady with NO VEINS...ok...so i'll try...first i try with a relatively large bore needle [18]...poke, and manage to hit the vein twice but it doesn't hold...darn 18...ok...poke again with a smaller one, a 20...poke, poke, nada..ok...a tiny 22...poke poke zilch...OK...a 24! poke poke poke poke poke.....nada...nada nada nada nada and nada...antecubitals...miss...hands...nope...neck...miss.....finally [half an hour later], try an EJ [external jugular]...poke poke poke over and over NADAAAAAAAAAA. meanwhile pt is not a happy camper [think hysterical crying]...perhaps should have stuck to "3 strikes, you're out" rule but nobody else around...so...called in a colleague...an expert who rotated with anesthesia [hat tip to expert line placers here] for 3 months...who has never met a stick he couldn't do...till now.. poke poke poke poke poke for half an hour + EJ attempts...nada....so now 2 frustrated residents, no IV access, and a lady who wld put swiss cheese to shame from all the holes...what to do?

call the senior.....suggest to him a central line or ultrasound.....
senior's answer - nope - we'll sign it out to nightfloat...time to go home

sorry lady....what can i do? time to go home. night float will take care of ya...
see ya in the am.

ps i called an expert PICU nurse to try before we left....she got a 24 in.....happy ending for all...
well for most of us...