> (donning bullet-proof underwear and not wanting to create
> another painscore)
>
> How about the argument that it's better for the patient? ie
> to only have
> one venepuncture (for the IV and bloods) rather than 2 - ie
> one for the ED
> IV, one for the 'routine bloods' that the inpatient teams are
> going to do
> anyway.
I agree with Adrian's argument that once the cannula is in and flushed, the
bloods can be drawn at any time (how do you think they do repeated sampling
on endocrinology units?). Also, there's a lot of patients have "routine
bloods" done who don't need a cannula or emergency bloods (I know there is a
reluctance to admit patients without a cannula in, but that doesn't mean
it's needed); and in patients who need emergency bloods but not an immediate
cannula, phlebotomy is a lot less painful than having a cannula in. Best
thing for the patient is bloods drawn from the acf; EMLA on the cannula
sites; cannula in once EMLA has worked.
One of the problems with this idea of cannula= bloods= cannula is that the
best place to draw blood from is the antecubital fossa, but conversely,
although it's a pretty easy site to place a cannula in an emergency, it's a
pretty poor site for a cannula (uncomfortable using arm, in a flexure, so
prone to infection, movement makes it likely to dislodge; and if you have to
withdraw it, then you've got a hole in a vein and can't place a cannula
distal to it.
Matt Dunn
Warwick
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