My top 10 tips on how to do venupuncture easily
Ambik darah adalah salah satu tugas yang agak mencabar and as a house officer, especially during medical posting, you need to poke about 20-30 patients during your oncall shift
Teknik ni sangat penting sebab pertama, anda tak membuang masa and yang kedua, patient xbenci anda sebab kalau anda try poke tapi xdapat2
1. Adequate lighting
- seringkali saya tengok sesetengah colleague saya bila nak buat venupuncture, diorang akan tutup semua langsir kat sekeliling patient. Well, kalau ada lampu yang terang dekat patient tu, should be ok. Kalau pesakit yang duduk di sebelah tingkap, xperlu rasanya untuk tarik tirai yang belah tingkap tu, so that bila cukup cahaya masuk, senang nak locate vein2 yang tersembunyi tu :-)
2. Squeeze technique
- Hmm, semua orang kata nak ambik darah patient nephro memang tersangat susah, why? because they're usually oedematous. So, lepas apply torniquet kat tangan patient, take your time untuk urut perlahan-lahan tangan patient or tekan kat bahagian yang ada vein, it works like you're examine pitting oedema, except kalau area tu ada vein,surrounding
dia akan tenggelam, but the vein akan timbul
3. Apply torniquet firmly
- xperlu apply too hard, but some of my friend apply it too loose. Takut patient sakit katanya, tapi which one is better? ikat tangan patient kuat, and single poke dapat darah or kesian kat patient takut sakit ikat torniquet kuat-kuat tapi poke 6 kali?
4. Lights/Pocket light/ Venoscope
- Well, saya bukan nak promote lampu energizer, but their keychain light is very2 useful especially nak locate vein in oedematous or paediatric patient. Kalau ada duit lebih
bolehla invest kat venoscope (50 USD). If patient tu oedematous, lampu tersebut akan menerangi seluruh bahagian tangan pesakit tu dan anda akan dapat locate vein pesakit easily. Rapatkan torch pada bahagian atas or belakang point yang anda nak poke. Well, the principle is like transillumination test in hydrocele, except kalau area tu ada vain, kita akan dapat detect dengan lebih mudah (cer try check link ni https://www.facebook.com/photo.php?fbid=1189741544387647&set=pb.100000554391883.-2207520000.1458497230.&type=3&size=629%2C456)
5. Take your time locating the vein
- Ok, anda dah apply torniquet firmly, tap on the patient's vein couple of times and kalau xconfident, jangan cucuk lagi. Cari alternative or kawasan yang veinnya sangat prominent. Xpe, ambik masa cari vein betul2, sambil2 tu sembang le dengan patient tu. Jangan cucuk je kerja, kesian kat patient
6. Ethyl Chloride spray/ EMLA cream
- kat government hospital payah nak jumpa menda ni, but you can easily find them at local pharmacy. Yup, spray ni sangat berguna (for me personally)sebab bila kita spray with adequate amount, patient usually takkan rasa sakit ila kita poke. Well, ada yang rasa pedih bila kita spray, but actually its because the spray was very2 cold that it creates a numbing effect kat atas skin patient. Kalau patient tak sakit, kan best untuk kita, then mesti dia cerita "doktor tu ambik darah xrasa pun...".
7. 30 degrees angle
- sesetengah orang saya tengok, angle bila nak cucuk jarum tu terlalu tinggi, making double puncture to the patient's vein, and some of them, the angle is too low, memang xkan dapat darah because you're in subcutaneous layer. 30 degrees angle adalah angle yang terbaik untuk kita cucuk, and if you done countless blood taking, you will feel a give away bila masuk dalam blood vessel
8. Stop after 3 times of fail attempt
- ok, biasanya kalau saya cucuk dah sampai 3 kali xdapat, and if I'm alone, I will get back to that patient later. Of course you need to apologize to the patient, but kalau ada colleague saya around, I will ask them to take it for me. Sometimes, memang kita tak boleh, n try not to take more than 3 times, kesian kat patient
9. Clean the skin adequately
- ok, jangan kedekut nak guna alcohol swab, clean area yang kita nak cucuk tu thoroughly, usually i will take 5 - 7 cm in circumference area tempat kita nak cucuk untuk diswab guna alcohol swab especially when you're inserting the brannula. And sometimes bila you wipe tangan patient, sampaikan alcohol swab tu jadi warna hitam, then, take and open another one, and swab it again until clear, this will minimize the risk of patient developing thrombophlebitis
10. Locate the veins merata-rata
- Don't just focus on the upper limbs, sometimes memang vein nya dah burn out ataupun terlalu halus dekat upper limbs, you can take it at the lower limbs as well (but clean the area properly). Cari sampai jumpa and kalau dah memang xde (eg in IVDU patient), alternative is triple lumen via subclavian vein, jugular vein ataupun femoral vein
Remember, venupuncture is 90% skill, 10% luck
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