Knowing how to choose the best vein for our paediatric cannulas unlocks the key to success.
Most of us have to learn this by watching others, and learning from our own failures.
Here are my tips on how to choose the best site to help you get that cannula in first time.🧵👇
When we first start out, we think just getting the cannula in is what matters.
After our cannulas get blocked or fall out, we start to think about why they don't work for as long as we want
The best vein is:
• juicy
• easily visible/palpable
• straight
• in a good location
The arm.
The best option is the arm + ideally it should be away from a joint.
Why do we want it away from a joint?
• It's really annoying for the child every time they bend their arm
• It's more likely to get blocked
• It's more likely to fall out
Back of the hand
If you can see the vein here you'll be on the path to a quick + slick cannula.
In babies they are often easily visible, but this can get trickier in chubby toddlers.
Also, those with kidney disease need arm veins protected for a fistula so the hand can be good
Ante-cubital fossa.
I find these really hard to cannulate in younger children.
• I can't see the vein
• It's hard to immobilise
In older children it works well (+ an ultrasound can help).
It's easy to forget though how annoying it is for patient to have a cannula here.
Foot.
This can be an easy option, but remember:
• In a mobile child it affects their ability to move around
• They have a higher fail rate
• They have a higher complication rate
As we continue to gain experience, we realise that at times this is our best chance of success
Back up options.
There are always times where none of these options are feasible. Consider ultrasound to help.
Scalp veins are a great 'wild card' in babies:
• shave the scalp
• choose a visible vein
Importantly, make sure the cannula always points towards the heart.
Tip #1: Think about why the cannula is needed.
I eventually learned that not all cannulations are the same.
Consider: is the cannula just needed for an hour or is it needed for days?
A foot or a joint would be ok for a quick procedure, but it won't be ideal for longer use.
Tip #2: Does the child have sensory needs?
Parents of children with sensory processing disorders or learning disabilities may tell us it's better in the foot.
This could be because it will:
• Be less noticeable
• Won't bother them as much
• Be harder for them to pull it out
Tip #3: The family knows best
This is the most important advice of all.
If we can, give them the choice.
• Consider hand dominance
• Be mindful of mobility
• Those with frequent cannulations know what works
Asking boosts our chance of success + gets the family on board.
The hardest part of learning cannulation for me was in chubby toddlers where you can't see a vein.
It took me years to realise the basilic vein was right there waiting.
It's so juicy that once you hit it, it threads like a dream.
Slowly I improved + now it's my favourite spot
TL;DR - Tips on choosing the best vein for paediatric cannulation
• Consider the arm, hand, antecubital fossa, foot
• Have a backup plan (scalp vein + using ultrasound)
• Think about how long it's needed for
• Be aware of sensory needs
• Ask the family where they'd prefer
If you found this thread valuable:
1. Follow for more threads on paediatrics and surviving medicine → @TessaRDavis
Organisational psychologist @adammgrant is best known for helping us find meaning in our work.
This month he delivered a TED talk on languishing: a sense of stagnation.
The cure for languishing is finding our flow.
These 4 ideas from Grant allow us to get out of our rut: 🧵👇
Languishing isn't depression. It's not burnout.
It's:
• muddling through your days with no real purpose
• the sense of 'Meh'
• the void between depression + flourishing
• the absence of the dreaded 'wellbeing'
Is that what so many of us have felt over the last 18 months?
At the start of the pandemic we all felt fear. But after a while that changed to apathy.
Our days felt repetitive. A sense that we were stagnating.
We didn't feel excited at the prospect of socialising again.
We spent hours doom scrolling and 'revenge bedtime procrastinating'
Gertrude B Elion was a biochemist best known for discovering groundbreaking drugs (6-MP, azathioprine, aciclovir)
She is one of only 12 women to win the Nobel Prize for Medicine.
As medics we have much to learn from her.
Here are 5 lessons on life + careers from Elion: 🧵👇
1: Don't be discouraged by being the first.
Most of us are disheartened when nobody's done it before, or we're told we can't do something.
Elion kept going after 15 rejections of financial assistance from Grad schools.
She was the only female graduate in her Chemistry class.
"Nothing worthwhile comes easily. Don't let others discourage you or tell you that you can't do it. In my day I was told women didn't go into chemistry. I saw no reason why we couldn't"