Tuesday, August 9, 2011

Tales from Residency: IVs

There was a rotation in residency where I did epidural injections under fluoroscopy every Friday. On my first day, the resident who was doing them the block before me was explaining to me and another resident what to do.

Resident: "So you take the patient into the examining room...."

Me: "Examining room... got it..."

Resident: "Have them sign the consent form..."

Me: "Consent form... okay..."

Resident: "Then you go ahead and get an IV started...."

Me: "You're kidding."

Resident: "What?"

Me: "Um, I don't know how to start an IV."

Other resident in room: "Me either."

Resident: "Well, you can give it a try."

Me: "Seriously, I've done it like, once. I could maybe draw blood if I had to, but there's no way I can start an IV."

Resident: "Actually, I don't really know how to do it either."

How many residents does it take to start an IV? Clearly more than 3.

I know it seems like residents should be able to start IVs, but there's really never any reason to do it when there's ancillary staff around. Nurses draw blood, insert Foleys, and start IVs. I just write, "Start IV." I'm really good at that part.

In fact, if I wanted to get good at IVs, it would have taken a lot of effort on my part. I would have had to show up early for surgeries or stalk nurses or something. So I didn't do that. And up until that day, it had never ever been a problem.


  1. Hah, the funny thing is, my mother's an RN. She and her friends have always expressed utter bewilderment at the "total inability of doctors to do anything useful, like starting an IV".

    I always thought I'd make sure I learned how to do that in med school. Then I found out how fiendishly hard it is (like you said, it takes practice), and how GOOD nurses are at it, and I was like... meh.. probably not worth it, compared to everything else I need to know.

    1. All doctors CAN start IVs. Many of them a too lazy.

  2. i always forget to push that damn catheter in!

  3. Thanks for sharing, Fizzy, I enjoyed the visit.

  4. Seriously? You mean put in a cannula etc and get the fluids started? That is standard intern scut in Australia.
    We do 7 or 8 per shift sometimes, and if you are on ward call you will do more. Actually, it is kind of fun once you get the knack. Right now when I'm there, I'll leap in and do it so the nurses don't have to on my current ED rotation. They don't need the practice, but I'm only in ED for a limited time.

  5. I always think about how funny it is when people say how glad they were when the doc started their IV for them, unless it was an anesthesiologist I am not sure its better than a nurse. Although if its someone you know who is good at it it might just be. I can put in IVs did it on my self...

  6. Why the ED nurses call us, the residents, when they can't get a line is beyond me. You do this 20 times a day, and now you want me, who does this maybe once a month to come in and magically get it?

  7. IVs are difficult, but we don't pass third year of med school if we can't do them (and a bunch of other things we have prescribed for Clinical Skills).
    Like The Girl, they are standard scut for us. I still suck at it though,but I can do it nowadays.

  8. @ERJ: as you know, it is because you possess the all powerful U/S machine.

    In fairness, I think that starting IV's and drawing blood is just one of those "boy scout" skills that every physician should be minimally competent in at some point in their training.

  9. ER Jedi -- Because drs are allowed to do arterial sticks, which nurses are not, at least not at my institution. Not that I can do one of those either.

  10. it's all about where you learn....if you learn in a city like Brooklyn, where I did, you sometimes have minimal ancillary staff and the byproduct is that you become skilled (still not as good as nurses, sometimes, though) at drawing labs, starting IVs and putting in foleys....

  11. Putting in ivs is definitely not one of the skills I picked up in med school. The last time I was called to do it was on a woman in labour about two years ago, and I felt terrible that I was contributing to her distress. Fortunately the much more competent nurse took over before I became an unhappy part of the woman's labour story.

  12. In the ER where I did clinicals, safety concerns prevented the residents from starting IVs. Specifically, if a resident ever laid a finger on the IV cart, the nurses would skin him alive.