For 3rd and 4th years...ABG's

[souljah1]

---

Members don't see this ad.

Greetings,

I'm about midway through my second year and I just did my first ABG today (took quite a while). I was wondering how common it is for 3rd and 4th year medical students to perform ABG's on their patients? I hit the wards in 5 months and I'm curious about peoples experiences. I had some problems at first finding that damn elusive radial artery despite a good prominent pulse.. I was pretty stoked to finally see blood entering my syringe. It was a bit more difficult than I had anticipated. I'd like to get a lot more practice and was wondering if people could share their experiences on drawing venous blood, arterial blood, and if you have done central lines/caths..well, share them as well. I felt like today was one of those mini-hurdles.

 

[KyGrlDr2B]

moving to clinical rotations.

 

[DOtobe]

I'm an MS-III...
And I have yet to do one. That's kind of odd (and cool at the same time) that you are doing ABG's so early. All I have done is started one IV line (haven't done much since I started off with psych and family practice, and then had a medicine rotation at a non-teaching hospital in which there wasn't that much for me to do). I haven't done any central lines or anything either - we're just supposed to observe them being put in.

 

[souljah1]

DOtobe,

I should have added that it was on a classmate, not a patient. After doing one, I was just wondering about what life would be like on the wards and whether or not I would be expected to draw arterial blood. It was actually a lot of fun. Had a classmate try and do one on me as well. Most of us look like little pincushions. Thanks for replying.

Anyone else?

 

[doc05]

I have drawn arterial blood a bunch of times, and it is usually pretty easy. It isn't always for blood gases; and I like to do arterial sticks in old people with bad veins: it's faster and you stick them fewer times. Remember to use a butterfly, since this makes it easier. You can use the tendon of the flexor carpi radialis as a landmark

IV placement is pretty common for medical students; central lines less so, but you will get practice during medicine or surgery if you're lucky (and aggressive). You can always do an ICU elective and gain tons of experience in central venous/arterial lines, etc.

I suspect you'll be doing lots of these sort of things since UCSF offers excellent clinical exposure. Why are you practicing arterial sticks on each other? they hurt!

 

[Mirror Form]

yeah, why the heck are you doing ABG's on each other?! We drew blood from each other, but ABG's are a lot tougher and deeper. I've taken ABG's twice and done one A-line so far during my third year, and they were all on heavily sedated pt's so it was great practice and pt didn't seem to mind. Those are definitley the best people to learn on!

 

[VentdependenT]

On my anesthesia rotation an attending showed me some study which states it takes 20 succesful attempts of any procedure to become proficient at it.

For what its worth.

 

[ERMudPhud]

Originally posted by doc05
Why are you practicing arterial sticks on each other? they hurt!

Not to mention the complication rate/consequences-higher than for venous sticks.

I certainly wouldn't let someone do one on me just for the hell of it.

 

[souljah1]

It actually didn't hurt at all. Thanks to a little lidocaine. Our whole class didn't do this, it was just a small percentage that was involved in some research (i shall spare the details).

As far as risks...we were well supervised by quite a few attendings.

It wasn't for the hell of it, and it didn't hurt that badly (2 on a 1-10).

It was actually a lot of fun.

The point of this post wasn't to talk about why I did it, but rather...how much experience with blood draws have you had?

 

[Neuronix]

I don't understand. I've talked to a number of patients who insist that ABGs are probably the most painful routine medical operation outside of dental work. My father (who has had tons of problems) insists that he hates them and has seen people pass out from the pain. Yet, some doctors and residents don't think that they hurt. What gives?

 

[DrMom]

ABGs clearly hurt.

I got to do 2 ABGs this summer in the ED (between 1st & 2nd years). Both, thankfully, were done on pts being coded so they didn't react to the pain.

 

[Jaded Soul]

I've never started an IV. Neither have the vast majority of students at my school. Most of the residents don't do it either. Nursing takes care of all of them. One time, a floor nurse couldn't start an IV on a patient and asked one of my residents to do it. My resident told her that if she couldn't do it, there was no way he or any of the other residents would be able to do it. They had to call in an ICU nurse to get the IV placed.

As for central lines, the residents insist on doing those themselves because they didn't get to do them as interns and students.

I've gotten to do a couple of ABGs, but nothing exciting. It seems like an anesthesiology or critical care rotation would be the best places to get practice. Either that, or be super agressive and ask the nurses to do everything.

However, the coolest procedure I've gotten to do was place ureteral stents under flouro and cystoscopy, so it makes up for it. 🙂

 

[Skrubz]

Didn't do my first ABG until my medicine rotation 3rd year but during that rotation I probably did 20 or so, with another 10 or so on surgery, and another 10 or so during my medicine sub-I. Of course, I did all of the above rotations at the VA so there was no one else who was going to do it, just me. Definitely good practice. A-lines are much more fun compared to ABGs. 😀

As for IVs, I had precious little experience during my third year (maybe 3 at most, was walked through all 3 times). During my anesthesia rotation though, I took it upon myself to do all the IVs for the first starts and managed to get 50+ over the course of a month. Have only had 1 look at a central line during my course in med school and that was on surgery call. The anesthesia attending knew I wanted to do anesthesia so he let me try, but alas, it just wasn't my night. I did get commended on my knot-tying though. 😛

 

[souljah1]

Originally posted by Neuronix
I don't understand. I've talked to a number of patients who insist that ABGs are probably the most painful routine medical operation outside of dental work. My father (who has had tons of problems) insists that he hates them and has seen people pass out from the pain. Yet, some doctors and residents don't think that they hurt. What gives?

We raised wheels of lido before we stuck for the ABG. The lido really numbed the 'target' area up pretty well. I watched a bunch of my classmates getting stuck and none seemed to be in pain. There was some anticipatory whincing, but no complaints of pain.

For all those who say their patients really complain..did you use any anesthetic first?


skrubz, thanks for sharing. seems like you where able to gather a good amount of experience. that is great. i'm hoping that my third and fourth years allow for this kind of stuff.

 

[Teufelhunden]

It's weird how varied our MS-III experiences have been thus far. I just got off of a 4-week Pain Management rotation and logged >50 fluoroscopy-guided epidurals (mostly caudals and lumbars, but some thoracic and cervicals). I also did tons of joint injections (mostly SI and facets), knee and shoulder injections, even some sympathetic blocks (stellate ganglion and celiac plexus, the latter being CT-guided).

Anyway, I've gotten to do all these procedures that few students get to do solo...but get this...I haven't done a single IV yet (?) the nurses seem to do them all (?)

Anyway, hopefully at some point I'll get to practice some of the "basics," cuz at this rate I'll being doing open-heart surgery before I get to do ABGs.

 

[Smurfette]

I've done 10-20 IVs, maybe 10-15 intubations, and a couple blood draws thus far in third year. I've had both a medicine rotation and anesthesia and haven't seen an ABG yet. Saw my first A-line this week (didn't get to do it though). That's it for procedures. Seems about average for med3's at my school.

 

[doc05]

Originally posted by souljah1
We raised wheels of lido before we stuck for the ABG. The lido really numbed the 'target' area up pretty well. I watched a bunch of my classmates getting stuck and none seemed to be in pain. There was some anticipatory whincing, but no complaints of pain.

For all those who say their patients really complain..did you use any anesthetic first?

there's little point in using lidocaine first. and you don't do ABG's unless you need to.

 

[Sheon]

I'm curious, why would they need an ABG?

 

[Teufelhunden]

Originally posted by Sheon
I'm curious, why would they need an ABG?

I'd imagine...to ascertain the patient's acid/base status (?)

 

[supercut]

Procedures done by students is highly variable from institution to institution. For example, if your school includes a hospital where the nurses don't seem to think that starting IV's is part of their job, then it typically falls to the residents, who often pass it off to students. If nurses are willing/able to start IV's at a particular hospital, students won't get to do that much.

If you are at a place where lots of central lines are placed and where interns are allowed to place them independently, then it is more likely that students will have the chance. MOre likely M4 students will get that chance. If you are at a place where central lines are avoided at all costs (and PICC lines more widely used instead) and the junior residents (PGY 1-2) must be directly supervised, the chances of a student getting to do a line is virutally nil.

I went to a place where lines are regularly given to students, got pretty good at doing subclavian lines completely independently. Now I'm at a highly supervised program where it takes attending permission and hands on chief supervision to start a line. I've done one as a resident vs about 30 as a M4 student. I've done a bunch of ABG as a student (mostly in the trauma bay). As a resident I've done none.

Consider yourself lucky if you go to a place where you get to do these things.