Well, I’ve run out of extra “M”s to add to the title. Let’s get right to the juicy stuff!

Since my primary field and time investment is the medical field, it’s natural that I’d derive some motivational moments from my work. Without such moments of fulfillment, it would be difficult to keep going with the intensity and time commitment that’s required. While these are quite far and few between the daily nonsense that goes on during this portion of my training (internal medicine residency), I hope that writing about these moments will put them to the forefront of my mind and remind me of the diamonds that can be found only by working within this field.

Multiple Successful Solo Peripheral Intravenous (IV) Line Placements using an Ultrasound

^{Image Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2818%2931380-1/fulltext}

Those are not my IVs!

However, my recent ones turned out rather decently. It was just a few weeks ago that, after 2 years of intermittent practice, I finally managed to place an IV line successfully on my own, using the lessons taught to me by more experienced residents. These were all done using an ultrasound to guide the needle, a skill that, in my experience, is only utilized by doctors in my hospital. When multiple nurses fail to place an IV line, we’re called in to use technology to save the IV access.

The reason that we’re not the first to do this is because we’re unfortunately rather busy taking care of multiple other patients. In an emergency, we’ll rapidly place lines, but in a regular situation it’s the nurses’ duty to try the lines first, as they’re the ones administering medications that we order. We’re taking care of 10-20 patients at a time – imagine if we spent our day placing IV lines on all patients! We’d have no time to play doctor.

However, there comes the time when initial attempts fail, and in comes the ultrasound and our collective experience. We use the ultrasound to find a reasonable vein, track it, then place the needle with the guidance of the ultrasound. We track the needle with the ultrasound to make sure that it’s actually in place and not penetrating somewhere we didn’t intend. This is the strength of using live imaging.

Now, my first successful IV from a few weeks ago… admittedly was not very successful. I wasn’t able to push it all the way in, as doing so obstructed flow. I didn’t follow through completely when tracking the IV. Hence, while it did last overnight, it was not going to last more than 24 hours in a best-case scenario.

Then, things truly clicked. Indeed, one of my mentors told me that one day the process “just clicks!” Boy, did it.

I placed the IVs, finding the tip of my needle on the ultrasound, getting good blood return, then slowly traced the needle tip until I was 100% sure it was in and staying in. The tracing took me a heck of a long time, but I’m sure this will speed up with more experience. I then tested out the IVs by flushing blood out, then saline water back in (we definitely don’t want blood clotting in the line). These IVs worked perfectly!

My 2nd successful IV, and the first that I would consider a good IV, was in a fairly large vein. It was still a proud moment… I felt amazing for an entire day after nailing that one. My 3rd successful IV was in a small vein – one that actually took deliberately careful manipulation and dexterity to place – but I did it! Several days later, it’s still working.

I will admit that I forgot one important step in the process: taping the loose end of the extension portion of IV to the arm (in the preceding figures, you’ll see that the loose end is taped down). However, my work was clean enough that the IVs were staying in regardless. The nurse taped them down to her convenience when I finished, but I will tape it in the future for good practice.

I’ll continue to practice these lines until I finish my residency. Once I hone my technique, I’ll also start teaching it to newer residents so that everyone will become adept at using ultrasounds, which are essential not only for IV lines, but for multiple other procedures as well!

Conclusion

Another set of memorable, successful moments in my budding medical career! During more difficult times, it’s useful to reflect upon and write about these little moments of victory. Recalling these moments always improves my confidence. It’s fuel for further self-improvement. 😁

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