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At the heart of general practice since 1960

Lesser-used skills

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Cannulation is a funny old thing. As a medical student approaching the end of training, it was always one of those things you wanted to get good at before you were let loose on the wards. You’d ‘have a go’ in order to get your skill up, provided of course you could see and feel a vein from the end of the bed, otherwise you were destined for failure. Then, on becoming a fully-fledged house officer, you would pride yourself on your ‘tricky cannulations’, those ones that needed multiple attempts from other doctors, the ones that ‘needed the anaesthetist last time’.  You’d compare scores with your junior colleagues, hoping you could be successful where they had not, hoping they wouldn’t be successful where you weren’t. You’d cannulate the most awkward of veins, finding a last, untapped vein in the most awkward of places – the elbow, the foot, the leg. And then, as your training progressed, you’d become further and further removed from this skill which you were once able to take so much pride in. It became a job for the junior members of the team, if not the medical students. 

Approaching the end of my current A&E job, I find that there is going to be less and less of a requirement for me to cannulate, or take bloods (I’m moving on to paediatrics - where it is almost a given that you will fail and the put-upon Reg will come and do the honours - then GP, then psychiatry, neither of which have much call for these skills), which I’m finding a bit odd. It’s like preparing to say goodbye to an old friend (contrasted, for instance, with saying goodbye to night shifts). There’s a great piece of writing in the Oxford Handbook of Medicine that encourages doctors to rejoice in the calm few moments afforded when taking bloods, those precious few moments of peace when the doctor can be alone with his or her own thoughts.

I can say with all honesty that I will miss cannulation and venepuncture; it can give not only a few moments of peace in an otherwise busy shift, but also a tremendous sense of satisfaction, of achievement.

 ‘Well done,’ I always say, as I finish and remove the tourniquet. The patient may have been scared stiff, or stoical, or anything in-between, but I always say it. It’s just not always the patient I’m saying it to.

Dr Tim Cassford is a GPST1 in Chichester

Readers' comments (3)

  • Kevin Hinkley

    Beautifully written, many thanks

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  • Great piece Tim, really enjoyed it... but don't dispair, your old friend will stay with you. Like a mate from medical school, you won't be as close as once you were but they will be there when you need them. And it will be like you were never apart!

    I last cannulated a patient in our treatment room, waiting for the ambulance. The time before that was on a home visit.

    Little scope for quiet contemplation in these acute settings but the skills has not deserted me.

    Best of luck with the rest of your rotation, look forward to seeing you 'on the other side'.

    Matt Burkes
    Langley House
    Chichester

    Ps when one of your psych patients collapses, make sure you know where they keep the cannulas -
    the rest of the team will be looking at you to lead the way!

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  • Mate, I'm a GP, and in the last year I've done countless cannulations, drained ascites, relocated shoulders, thrombolysed MIs, inserted urinary catheters, and removed dozens of BCCs and SCCs - I could go on - the only difference: I now work in Australia. You can keep your hands-on skills here.

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