Lines and BP cuffs on arms with lymph node dissections.

[urge]

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We once had an in-service on the use of IO lines, part of which admittedly was given by a rep for the company that stocks ours, but he brought quite a bit of (biased) convincing data to demonstrate that their insertion is not substantially more painful than peripheral IV placement assuming that 1) appropriate topicalization and 2) proper, slow initial injection.

And you believed him?

Why didn't anyone try one on themselves? "It doesn't hurt that much."

There is also a risk of osteomyelitis with those lines.

 

[Planktonmd]

This whole idea of avoiding needle sticks is basically nursing dogma and metaphysical thinking that somehow evolved into a doctrine that keeps being taught to people (physicians, nurses and patients), It is taught as a religious belief that you have no choice but to accept regardless of how ridiculous it is!
And that's why you find people with concrete thinking and underdeveloped logic so happy to embrace it and defend it.
It is comparable to other silly nursing ideas like the need to wear a mask for anesthesia staff in the operating room or the stupid time out rituals that were inflected upon us.
The problem though if you don't adhere to local policy and something actually happens then you will be crucified by everyone, so you have no choice but to do what everyone else is doing, but if you need access in that arm and the other alternatives carry higher risk then you document your thought process, you explain it to the patient and do what you think is right. That's why you are a consultant in your field and not a nurse!

 

[Twiggidy]

But it bears questioning, why risk the possible trouble (or even worse litigation as FFP brings up often) when there are other options (other arms, necks, feet, groins, gases, ketamine, etc) It's all risk vs benefit in the end but why invite trouble?

All of it in the end is doing what's in the best interest of the patient. Do no harm (or do the least amount of harm possible)

 

[deleted171991]

I did not realize I bring up litigation so often. But when we have a bad outcome, after having chosen a suboptimal way to skin the cat, in a litigious society, we invite lawsuits. This is why the American version of "primum non nocere" should be "first, do no harm to your own family".

So do whatever invites the fewest bad outcomes in your experience. The fact that the patient agreed to the risks doesn't absolve you, in the US. You'll have to prove to a jury that it was the best choice, that you chose the lesser of two evils. The patient is not supposed to understand medical decisions and risks, even if you chew, swallow, digest and regurgitate them for him/her.

 

[Twiggidy]

I did not realize I bring up litigation so often. But when we have a bad outcome, after having chosen a suboptimal way to skin the cat, in a litigious society, we invite lawsuits. This is why the American version of "primum non nocere" should be "first, do no harm to your own family".

So do whatever invites the fewest bad outcomes in your experience. The fact that the patient agreed to the risks doesn't absolve you, in the US. You'll have to prove to a jury that it was the best choice, that you chose the lesser of two evils. The patient is not supposed to understand medical decisions and risks, even if you chew, swallow, digest and regurgitate them for him/her.

je adore your advice on her because it literally reminds me everday, "Don't be stupid."

 

[Planktonmd]

je adore your advice on her because it literally reminds me everday, "Don't be stupid."

It's spelled: J'adore !

 

[deleted171991]

It's spelled: J'adore !

Sois gentil, docteur Plancton! 🙂