I used to love Tony Robbins, reading his books and watching his shows. I still think he's awesome, but hadn't thought much about him until this past week. One of the things he promotes is from the Japanese concept of 'Kaizen' which in simple terms is to commit to constant improvement in whatever you're trying to achieve. Never being satisfied with your performance, and looking for little ways to improve. This really resonated with me when I was younger, and I've worked to implement this in my own life.
What really got me thinking about it this week however, was a simple blood draw. With surgery upcoming, the surgeon wants to make sure I'm healthy and all that, and it's standard to draw some blood and run a few tests to make sure the system is operating within normal parameters. No big deal. I have zero issues with needles. Back in the day, we practiced on each other in Paramedic school, and since then I've let nursing students and other people training to start IVs and draw blood to practice on me. I don't have much pain with it, even though I bruise like fruit and sometimes come away from those sessions looking like a junkie.
I preface all of this by letting you know up front that I am an easy stick. My skin is quite light, and while some veins are not visible to the eye, they are easily felt and not very deep. My veins aren't particularly prone to rolling or blowing. I also have quite a bit of experience with both blood draws and IV starts. I am fond of telling people "I used to do this bouncing down the road in an ambulance with very little light." I am not a "vein whisperer" by any means, but I'm better than average, I would say. Working in the ER as a nurse gave me opportunity to regain my skills from years ago as a Paramedic and expand on them.
Drawing blood requires a slightly different technique than starting an IV, but they are similar enough that we tend to discuss the techniques interchangeably. It's a skill to be sure, so my next comment is not intended as a denigration of the people who do it. It is not rocket science. It doesn't take dizzying intellect or some special knowledge, nor is it an unachievable skill for most people. People who are particularly good at it usually are happy to give you tips and tricks they use, and with the advent of the internet there are dozens of places to go for information including videos about improving your IV skills.
So it always surprises me a little and seriously disappoints me when medical professionals who need to draw blood or start IVs regularly just throw their hands up and say "I'm not very good at this." It reminds me of a scene from one of my favorite movies where a hunky Viking throws Antionio Banderas' character a sword, and he complains that it's too heavy to use. The Viking's response? "Grow stronger."
So my surgical intake nurse this week was very nice, and seemed to be a very competent nurse. She wasn't a new grad by any means. As a surgical intake nurse, she probably has to draw blood on a dozen people or more a shift. I could tell she wasn't terribly comfortable with the draw, so I tried to reassure her by letting her know that I'm not a hard stick. She flat out told me that she can't really feel veins at all. This floored me a bit, since you can't see the veins on most patients due to skin pigment, tattoos, scars, hair, and more. We are taught to evaluate the veins by feel. Location, direction, valves, "bounciness", and size are all things we tell from feeling the arm.
One of the large veins that is almost a default for blood draws and often for IVs is the antecubital, which is on the inside of the bend of the elbow. You know the one I mean, some of you are cringing and pulling your arm in to protect it as you read this. Mine is fine, no issues with sticking it, pretty much ever.
She missed it. Clean.
Which I should be happy about, since that means it doesn't bruise. But there's no reason for it. I was hydrated and in reasonably good health. So she moved to my forearm where she could see the vein. Long story short, she went through the vein. Which is actually quite common with people learning to do blood draws, but they usually get better. It makes for a leaky IV and blown veins if you're trying to start an IV, but it doesn't usually screw up a blood draw. So she got the blood she needed. And I got this bruise:
I'm honestly not upset with the nurse. Like I said, I routinely let people practice on me. But I am disappointed that she doesn't seem to be trying to get better, she's just accepted that she's not good at it. In her position, that means that people who are harder sticks than I am get stuck way more than they need to. She did state that if she didn't get the second try, she'd get someone else. Which is good, because it at least limits the number of sticks and bruises. However, there are people for whom even this article is painful. They have a real anxiety about needles, and it's traumatic for them to have repeated sticks. Some people are truly hard to stick, and while they're usually patient, they need people who are working to improve their skills, not people who have given up.
When I was working ER, it was a point of pride that I was pretty good at IVs. I enjoyed having people come to me for help when they were having problems. I liked passing along the tips and tricks that worked for me and seeing my cohorts improve their skills as well. When I worked with honest-to-goodness vein whisperers (and I worked with several) I watched carefully how they did things, and asked questions. I sought out internet resources to find new information about ways I could keep getting better. I would ask for help when I was outmatched by a patient's veins, because I wasn't going to turn my patient into a pincushion. But it was my goal to be the person who, if I couldn't get a line, the patient needed a sonogram placement or a surgeon to place a central line. I wouldn't be satisfied with myself until that happened.
Kaizen isn't an obsession with perfection. It's a commitment to becoming just a little better every day. That's a healthy approach, and one we should all embrace.
Especially if you draw blood every day. Just sayin'.