Hi 

I think inserting an IV line requires skill and knowledge so they need to have the basic anatomy to understand the best way of insertion by attending a breif 4 hours class.

In the other hand and during emergency there should consider  intraosseous cannulation as a back-up

Dear Mariam and Samar, lets put it this way - there was a time up to 1980 all doctors of all faculty made it a point to learn and master the skill of puncturing a vein to set a cannula for a I V infusion and also to draw blood - but as time went Phlebotomist are categorized for withdrawal of blood and nurses are the only people to set a I V plug -  what to do? who made this rule -- well they all should be blamed for your grief and sadness. Thanks 

Dear Samer,

For a brief 4 hours - still, the skill and knowledge are lacking. It seems that the relevant medical officers could not master them at all judging by the complaints received.

Indeed, during emergency, intraosseous cannulation as a back-up has its own risks too and it is usually for short term period only. It is not even viable for the elderly with weak bones too and those accident patients with broken bones.

In my country, the cannulation is never a medical protocol during emergency at public hospital - that makes it more scary.

Dear Dr Tajudeen,

I am not sure of who made the rule as to let only the Phlebotomists to take blood and nurses to set the IV plugs.

It is not so much of grief or sadness but frustrations that when the Phlebotomists are lacking and always off duty at night and the nurses are ill-equipped to set the plug, the last resort of calling the HO, MO, Reg and Consultants reveal none could set THE plug at all or take the blood - ABG included.

Imagine if the patient is your good self - would you not worry to death that you'd be dying without help when help is supposed to be right under your own nose?

No offence though but I have seen many who suffered due to this lack of basic skill which should never be at all.

Best regards - Mariam

Dear Madam, I agree with all my heart as what you say is the most saddening truth, but then again "Is there a clinical evaluation for all types of route of administration done as a practical clinical examination for the medicine undergraduates"? -- well ---- then every doctor at undergraduate level will have some skill to do. there is something missing and lacking for this great black hole in our doctors community. How to solve it unless every doctor who at least realises the lack of skill and learn it for good ethical commitment in the profession by themselves. Hope the day comes soon. Thanks

Dear Dr Tajudeen,

Based on the Q & A I did with the phlebo, nurses, HOs, MOs and randomly with Regs and Consultants, Surgeons - they are well-equipped with the knowledge and skill. It is their couldn't-care-less attitude which diminish my respect for them because most quote -

1) Their immediate families and relatives are not involved in the procedure (not hospitalised there and then) hence no urgency to learn the trade

2) Their supervisors never checked on them (some don't even know how to insert or cannulate themselves) thus leaving the onus and liabilities to the non-skill HOs being on the "ground" mostly.

3)" If their leaders could not perform such basic skills, why bother?"

It is indeed pathetic that such respectful professions do not even bother to take up this basic skill and knowledge totally nor those well-equipped, to teach their protégé the best practices possible. This go all the way up the Ministry of Health level.

I too yearn for the time when this trend could be reversed soonest possible.

As it is, money is more important than human lives for as long as they are not their very own flesh and blood.

Much as I hope the reverse were to come, as of now, the status quo remains "Do NO Good" and "Do NO Harm" is nothing but the truth .

Sadly yours - Mariam

Dear Dr Tajudeen,

Based on the Q & A I did with the phlebo, nurses, HOs, MOs and randomly with Regs and Consultants, Surgeons - they are well-equipped with the knowledge and skill. It is their couldn't-care-less attitude which diminish my respect for them because most quote -

1) Their immediate families and relatives are not involved in the procedure (not hospitalised there and then) hence no urgency to learn the trade

2) Their supervisors never checked on them (some don't even know how to insert or cannulate themselves) thus leaving the onus and liabilities to the non-skill HOs being on the "ground" mostly.

3)" If their leaders could not perform such basic skills, why bother?"

It is indeed pathetic that such respectful professions do not even bother to take up this basic skill and knowledge totally nor those well-equipped, to teach their protégé the best practices possible. This go all the way up the Ministry of Health level.

I too yearn for the time when this trend could be reversed soonest possible.

As it is, money is more important than human lives for as long as they are not their very own flesh and blood.

Much as I hope the reverse were to come, as of now, the status quo remains "Do NO Good" and "Do NO Harm" is nothing but the truth .

Sadly yours - Mariam

  In this era, IV line  insertion is must learn basic skill. Skill of IV line insertion should be compulsory for all health care providers. Being Anaesthesilogist,  I believe that in emergency medicine settings, most of the drugs are injectable. Therefore, IV Line may serve as  Life Line in emergency. 

Dear Jai,

Sadly, this is not so prevalent in my country, as yet especially in ED environment.

Even after using ultrasound, they still could not find "good" vein to insert the IV line.

Once, I personally saw an Anaesthesiologist insert the line only to have the line site greatly swollen immediately after the surgery was completed. He was lucky the surgery lasted for an hour, imagine if it lasts for two hours or more -  and he did not realise the swelling !

Patients lives are compromised greatly.

I just do not understand what is our current ED or Anaesthesiologist life line protocol  because the shortest route failing which they take is usually IM instead, which is not relevant for some procedures depending on the illness(es) presented.

I truly wish that this skill should be highly compulsory before one graduates and practise immediately and mentored accordingly as human lives are at risks every moment the life line is not inserted timely.

Best regards - Mariam

Dear Jai,

Sadly, this is not so prevalent in my country, as yet especially in ED environment.

Even after using ultrasound, they still could not find "good" vein to insert the IV line.

Once, I personally saw an Anaesthesiologist insert the line only to have the line site greatly swollen immediately after the surgery was completed. He was lucky the surgery lasted for an hour, imagine if it lasts for two hours or more -  and he did not realise the swelling !

Patients lives are compromised greatly.

I just do not understand what is our current ED or Anaesthesiologist life line protocol  because the shortest route failing which they take is usually IM instead, which is not relevant for some procedures depending on the illness(es) presented.

I truly wish that this skill should be highly compulsory before one graduates and practise immediately and mentored accordingly as human lives are at risks every moment the life line is not inserted timely.

Best regards - Mariam

I am sorry about your experience, but in my institution, IV line insertion is a basic skill that is taught on the 3rd year of medical school, with competencies for IV insertion expected by the time they graduate (4th year).  

In our Paediatric ED, all residents are competent with IV insertion, and are able do intraosseous insertion which can be maintained for 12-24 hours, upon which is the time that we may be able to insert a peripheral line. Central line insertion is done by the PICU and Pedia Surgery service.  As of the late, I only know 1 or 2 people that employ the use of the ultrasound to do this.

That being said, to answer your question - I think it matters that medical and nursing students are taught the skill of IV insertion.  Our paediatricians at the ED have the distinct advantage of encountering smaller veins, and thus have managed to develop special manoeuvres and skills.  I cannot imagine working in an ED with most people not knowing how to insert a line, and can understand the frustration you have with this situation.

Inseting an iv line needs experience. And  practice , a lot of practice. There other ways like intraosseous cannulation and santral line but in some cases and iv line can save lives. In my practice nurses do all the iv line insertion and doctors do it when nurses can not. But all our stuff has the ability to access a difficult iv line. 

Dear Hulya,

True enough, such are the practices but most often - even the protocols does not work at all.

I respect those junior staffs more than the HOs, MOs, Regs, Consultants and some even Surgeons (not all) who could not even find a single IV line in just one shot some in ED environment especially.

I once saw the cardiac catherization surgeon prod blindly the catheter despite using guided fluoroscopy and went into force blocked elbow and shoulder owing to sadistic personality disorder.

Another was few MOs finding lines going over all four limbs on a poor patient for 5 times each (that's 20 useless shots) simultaneously for a mere MIBI procedure leaving the patient faint during the painful episode.

The sad thing about the one I saw right under my nose was the fact that few MOs and Reg trying to insert a mere IV line for a Code Blue GCS 3 patient to no avail. On the 30th time after a 5 hours attempt using Ultrasound machine only then the saline gets working together with other blood tests and medications. Imagine if the patient has heart attack and needed the necessary IV medication, he would have long died without any help from these so-called "professional experts".

Those with basic practice is never sharpened nor there at all but hiding behind the vast brainy knowledge and bragging alone (not all) with no skill to boast of except to lecture their juniors into performing what they lack for fat paychecks. My main worry is what if they are surgeons and they cannot even find the right vein or differentiate the artery in open surgery and cut off everything in the name of science and experiment. Sounds ridiculous but it happens in our daily lives.

It is truly a Hitler-like era where everything is experiment under the guise of perfection. Sadly, this basic skill is still not a requirement to pass any basic, intermediate or advance module for mere medical study in my (?) country, pathetically. It is the immediate diagnosis which is most important and never the need to medicate urgently.

If a simple IV line cannot be simply inserted, what about central line, jugular line and all the important lines save those easy intraosseous jab that any non-skilled paramedic can initiate just like uneducated insulin-jab patients could do.

That much my concerns and sympathy lie.

Best regards - Mariam