Blitz2006

10+ Year Member
Nov 20, 2006
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Hey,

IMG interested in IM for residency. Just wondering how competent I should be with these skills if I do match into residency, as well as a bit curious.

I hear that in the U.S nurses do most of these skills, like drawing blood, cannulas, doing IM/IV/Sub-cut injections..is this true? Or do residents also do these jobs?

Thanks,
 

w a n g

blarg
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Apr 19, 2007
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Not sure what you mean by cannula, but most residents should be proficient in blood draws/IV insertion/blahblah. Those you mentioned are definitely the more simple ones.. Now how much you actually have to do these may vary greatly from location to location. Some places VERY rarely.

There was a thread back a few months about the IM procedures (arthrocent/paracent/A-lines/triple lumens). Those are the real procedures to (almost) worry about!
 

km11

R1
Sep 22, 2010
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Medical Student
From what I hear, it's very institution/area dependent because of nurse staffing. At my school med students and residents pretty much never do lab draws, IV lines etc but they all end up being qualified for the more advanced procedures that nurses aren't allowed to do.
 
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Blitz2006

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Nov 20, 2006
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Sweet, thx for quick responses.

I think cannula = British term. But I googled it and cannula = IV Insertion.

So Wong, you got me 'worried' now, :p, since I will not have had much experience with those advanced procedures you mentioned....am I screwed then for PGY-1 or will there be other interns in the same boat as me?
 

w a n g

blarg
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Pretty much everyone is in the same boat and learns it along the way. No worries.
 

WorkaholicsAnon

10+ Year Member
May 7, 2008
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Yeah the problem is that even when nurses and techs do most of the IVs and blood draws, when a patient is a difficult stick and neither one can get it, guess what, they are going to be calling YOU to do it.

Crazy I know. It makes no sense whatsoever.

The best place to learn how to do IVs is on an anesthesia rotation. I dont know if IM residency programs have much flexibility to allow you to do one, but if you're an IMG who has very minimal experience doing these, it could be worth finding out if maybe you can do an off-service anesthesia rotation early on to just learn IV placements (it's really easy btw, once you get the hang of it).

For blood draws, if you find a nurse who likes to teach and it's not a very busy time, they are usually thrilled to teach you. I ran across this in the middle of the night in an easier ICU i rotated through on just an unusually relaxed night. You may need to make it clear to them that these skills are not taught in med school (because for some reason some nurses assume med schools do cover this).
 

drfunktacular

ANA ≠ SLE
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Oct 5, 2004
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I would be wary of any program where you are expected to do any of these things, as they are defined even by the ACGME as "service" obligations rather than "educational" ones.
 

Scottish Chap

Moderator Emeritus
15+ Year Member
Aug 3, 2003
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Hey,

IMG interested in IM for residency. Just wondering how competent I should be with these skills if I do match into residency, as well as a bit curious.

I hear that in the U.S nurses do most of these skills, like drawing blood, cannulas, doing IM/IV/Sub-cut injections..is this true? Or do residents also do these jobs?

Thanks,
It varies by institution as others have said. I'm a resident in a very large hospital in a very large city in the U.S. so those techniques are definitely going to cross your path a lot down here (and I work in a hospital with decent ancillary services). I lost count of the number of blood draws I did as an intern. I even had a couple of ED nurses refuse or state that they can't start an IV on a patient, so I ended up doing it.

In the grand scale of things, they are simple procedures that take time away from thinking about the patient's disease, and that's never a good thing in my opinion. I'm kind of old school though, and feel that every doctor should be able to do these things is they are asked. If there's an emergency, you'll be expected to perform. I spent a couple of days in the PACU as a medical student and the nurses there were great - they taught me how to start IVs on hard patients. Like anything else, it's a skill you lose if you do not keep it up. In the end, don't worry: after a month in the ICU, you'll be great at ABGs, drawing blood, putting in NG/OG tubes etc.

P.S. I'm surprised you didn't use the term "venflon".