Sunday, September 23, 2007

The CT scan


Had the CT. Good thing I took the night off because I didn't feel "ok". I wasn't nauseated or anything... but I just didn't "feel ok".

So I drinks my prep with my dinner the night before.

Pitch, toss and turn in bed trying to get some sleep during the night - my usual "awake time".

Get up all grouchy after three hours of sleep when my alarm goes off. I've given myself an hour and half to shower/get ready and drink my morning cat-scan prep.

All goes relatively smoothly (warning to anyone considering/needing a cat scan in the future. If you don't hate Banana, take the Banana flavor smoothie. The Berry flavored one sucks!)

I drive meself over. Pre-registration goes fine.

I'm taken down to "pre-scan" area. Requisite health history is repeated. I see a very nervous CAT Tech student hovering around. She asks if I don't mind if she started the IV on me. I smile and say "not a problem!” I remember being a student once - we all gotta practice, right? And who better to practice on and build confidence than on a young feller with tree trunk veins? :)

Right away, while she is prepping, I notice ... well, "technique issues" (My tourniquet is not too tight, she's trying to "see" the vein rather than "feel" it, and when she thinks she's found one, she doesn't try to see/feel it's direction etc.) I generally try and keep my mouth shut - I don't want to come across as a smartypants. The only suggestion I offer is when she does the skin prep - gently I tell her with a smile: "Ma'm (though she is probably 18 years old), it works better if you really rub and scrub it during your process".

She blushes and proceeds to vigorously scrub my skin.

At this point she is ready to cannulate me and I can tell she is dreadfully nervous. I'm used to seeing folks poke my veins (I donate blood Q 2 months and watching an expert nurse drop that 16 G needle into my vein is one of the highlights of the whole process :D)... but I figure that my gawking on would probably be counter productive.

In stead, I try and play the "usual patient" routine and pretend to 'close my eyes in anticipation of the "painful stick" that is to come'.

I feel the poke and I feel her digging around. It isn't painful yet, just a tad bit uncomfortable. I crack my left eye open on the sly to see what's going on. She is digging around, her forehead knotted in concentration, trying to get that magical "flash" in the blood chamber signaling a successful IV stick.

After a dozen seconds of digging around, she flips over her shoulder to look at her preceptor - as if to plead for help. Preceptor says quietly, "Pull it out. Let me take a crack at it".

So she pulls out. Disappointment writ all over her face. She tapes my failed site down with LOTS of gauze and too little tape.

I bite my tongue yet again rather than do some 'constructive criticism' about the need for "pressure on the wound", "elevate the site over the heart for a few minutes" and "fold a piece of gauze over to form a square and use a good amount of tape (especially on males because of abundance of coarse hair) and use pressure when applying the tape/gauze combination to ensure restriction of blood flow".

I make a mental note to talk to the CT department about their preceptorship of students. I note a distinct lack of guidance and encouragement from the "preceptor".

For some reason, I figured this might be a 'nice' time to step in.

I volunteered that I'd be willing to have the student have another crack at my other arm for sticking a vein. The whole flurry off "Are you sure?" type questions followed and each time I answered in the affirmative - I was willing to have the student take another shot at cannulating me.

The student looked like any student would at this point - grateful that they were being given a second chance... and yet horrified about facing her past while trying to achieve a positive outcome again!

(I know precisely what the student was feeling - not too long ago, I too was a "student preceptee" but in a Trauma ER. There, I was schooled in the fine arts of "IV cannulation" by a kick ass ER nurse who had been at that job for 22+ years. She rode my ass unmercifully on all aspects of the job (but her forte seemed to be IVs) - but it is all thanks to her that I picked up some of the salient points of IV insertion.

And boy! Am I thankful she rode my butt back then! Where I work right now, I am the "go to guy" for starting IVs - never mind that I'm not exactly "Mister 20 years of experience!")

But anyway, I extended my Right Arm. Stretched it out good.

As the student (let's call her "ST" sat down with her supplies, I talked in a low, calm, assuring voice:

Me: "You're gonna do great this time. Trust me, I know"

ST: (half laughingly) "Yeah? I hope so"

(Tries to tie the tourniquet on my arm. Ties it on too loose again)

Me: "Pardon me. I don't mean to be a jerk, but I think you might get better results if you tied that tourniquet on a lot tighter. Now, don't worry about 'discomfort' - remember, it's important that you get the IV in, right?"

ST: (Looks at me a bit quizzically but decides to follow through) "Ok. Let's try that again...

Me: (As ST is re-trying) "A little harder... a little more... that looks about good!" I smile

ST: (Smiles) "Ok then! Let's get a vein. Ope....."

Me: And before she can begin her sentence, I'm pumping my fist. "Ready when you are", I grin.

ST: (blushes) "Ok, Let me take a look".

At this point, her preceptor is curious - I've been giving an awful lot of feedback to her student. I'm pretty sure it's something she doesn't expect her average CT scan patient to give... her question doesn't strike me as something out of the ordinary:

"So, are you a CT scan tech? Do you work around here?"

Me: "No M'am!" I grin. "I'm a registered nurse. I work upstairs. I send folks down to you guys for their CT scans all the time."

I quickly turn my attention towards her student, who is still furiously looking for a vein. As gentle as I can, I tell her "try to feel for one. When you push/bounce on a good vein, it should feel spongy. Looks are not all they seem - sometimes a vein that looks good is probably not the best one to hit".

Probably not the best description - but given the circumstances, it should work. I have very good veins on both my arms. She just needs some pointed guidance. I try to guide her, gently; towards the rope of the vein in my AnteCube...

Me: "Little more medial.... little more... just a tad bit more... ok, you're close. You should able to feel a spongy, thread like structure. You're roughly close to the middle of my inner elbow."

Gently, I reach over and grab her index finger... and guide it to my Median Cubital/Basilic vein (for a clickable look at the anatomical position of this vein/site - click here! (WARNING: "Graphic content" of human cadaver used for illustration purposes!)... and gently press on the site.

"There... feel the spongy nature? You try it"

ST: "Ohhh! Ok! I feel it! You're right! It's nice and ... and... 'spongy'!"

Well! I wish every one had veins like I do! But that's a lesson you're gonna have to learn on your own. First things first though...

Me: "Ok. Now try to see which way that vein goes. Try and get a 'feel map'. Is it going straight up and down? Is it going off at an angle? Is it straight for an inch or so or does it get crooked?"

ST is busy trying to concentrate and palpate my vein. Judging by the pressure exerted by her fingertips, I can tell she's arrived at a decent understanding of the direction my vein takes.

She announces excitedly: "Ohhh! You're vein is good and straight! But it just goes off at an awkward direction in your arm!"

I tell her that while anatomy textbooks try and provide a good terrain map, human beings are individuals and are thus bound to be varied. I tell her to get her "stuff" ready (tape, Tegaderm, saline lock). She vigorously rubs the IV site (Hey! She's learning already! :)) in preparation.

As she's about to insert the IV, I tell her to pause and take a good, deep breath. Then I look her in the eye and say "You can do this. Just remember the position you just found, the direction the vein took, spread the skin before you poke and remember to start at a low angle and go slowly. Don't worry about hurting me - you won't. I know you can do it right".

I then turned away and closed my eyes.

I felt the poke... and felt her digging around some. I resisted the urge to look ... just maintained the calm demeanor. Suddenly I heard a yelp:

"Blood return! BLOOD RETURN! Blood Return!"

I felt her clumsily retract the needle - while forgetting to put pressure on the IV site.... almost instantly; I felt blood flow down my elbow through the IV site.

ST: "CRAP!", she swore. But in a frenzy of activity, she managed to hook up a saline lock in no time. As she was wiping up some of the blood, I opened my eyes and winked at her...

Me: "So, it wasn't that hard was it?", I said with a grin.

ST: *blushing* "It was! But I still made many mistakes!"

Me: "Well, those weren't critical mistakes. And you did choose to overcome you fear and failure to give a good attempt again. I'd call this one a "decent try". :)

ST: *still blushing* "Really?! Wow! I thought I'd screwed up major time!"

Me: "ST, nobody is a born IV sticker... except me, of course!" I grin. "But you did well, given your circumstances. Just remember: Dependent arms, tight tourniquets, feel the vein and stick it with confidence", I said with a wink and a smile.

And with that, I was ready to head over to the CT scan....

So, I walks into the CT scan unit.

Facing that big "donut like thing", I quietly tells myself "this is it Spook. Hope the results come out all ok!”

I take a good deep breath, walk over to the counter and take off all "extraneous items" - watch, keys, cell phone, wallet, dog tags, and my belt.

I quietly lie down on the bench. They cover me with a blanket and ask me to lower my pants to my knees. I comply. Then they ask me to raise my arms over my head.

First we "shoot" my abdomen "without" IV contrast [IV contrast consists primarily of Iodine solution]. I 'travel' in and out of the donut - being asked to "inhale and hold my breath" every so often while they take pictures of my abdomen before being told to exhale.

The night before (and this morning), I have swallowed what's known as "Redi-Cat" - a solution that primarily consists of a Barium Sulfate suspension. This solution has been swimming around in my body for a while and now they've taken pictures of by innards - the Barium Sulfate helps identify certain body organs and innards.

Then comes the "Pictures with IV contrast part".

During this session, they "shoot" (literally deposit about a 100 ml of solution real fast. This is the primary reason why CT scans require "good" venous access) Iodine contrast solution directly into my veins.

I was told to expect "feeling warm all over".

Lemme tell ya, it ain't nothing like you think it would be!

When they says "warm all over" - they means "warm all over". And not a "slumber-party-under-the-comforter-warm".

WARM! As in "hot"! You suddenly feel freaking HOT all over. From you head and shoulders, your chest.... to your belly... then in a very awkward way... your genitals too (men - by that I means your testicles and penis!)... before it reaches down to your feet and toes.

All of this happens within seconds! So while you're there feeling semi-assaulted; you're 'drawn' into the CT machine again. Again the command comes: "Breathe in.... Hold your breath".

They did this once and I felt semi-nauseated. Still trying to fight off/get used to that funky, hot, warm feeling between my legs and in my gut, I was slid into that machine again.

Once again, I was told to "Breath in.... Hold your breath".

However, this time... something was wrong! My stomach basically decided to call it quits! This wasn't an 'ordinary issue of stomach issues' - my stomach pretty much just up and quit!!!

I felt stuff regurgitating up my throat!! I felt myself being dragged out of the scanner... all the while trying desperately to hold my position as requested - hell, I didn't want to screw up the damned test and have to do it again!!!!!

As I was being mechanically pulled out of the scanner, I frantically waved my arms, and began pointing fingers into my mouth in the sign of "I'm gonna puke right now!"

I waited for back up. In fact, no back up came...

I ended up turning myself onto my side to mimic the "Recovery position" and proceeded to spew vomit onto the side of the scanner-bed and onto the floor. I vomited about 100 cc worth of my morning CT prep of Berry flavored Redi-Cat (*yuck!*)

Almost as soon as I was done puking, I began analyzing myself: "Ok, respiratory rate seems fine and other than the nasty shit I regurgitated as I was puking, my airway seems to be ok. My heart rate seems a little high, but we're not way up there yet. Ok... looks stable for now".

I leaned back/semi-sat up in that cat-scan-bed/stretched.... breathing through my mouth, retching the last of my vomit, trying to clear my nasal air passage...

"You ok, sir?

Where the HELL were you lady when I was puking?!! Do you realize that in the position I was in, I could have choked/aspirated in my own vomit??!!

"No I think I'm ok. Just have the residual effects of vomiting. I'm not nauseous. I'm actually pretty sure that I tolerated the Iodine IV injection just fine but when you asked me to "Breathe in and hold your breath" was then I started having a problem. I'm pretty sure it's gas related."

[I intend to follow this up with Radiology. It's fine and dandy that I am a young buck, trained in healthcare that was able to look after himself....

.... but what if I was an 85 year old vomiting on that scanner?!! Heck, no body rushed in! And when they did, no body bothered to turn me over to my side lest I aspirate my own vomitus! Me thinks a tad bit of training is due here!]

"Ok, Sir. Why don't we get you up and get you cleaned".

I pretty much proceed to get myself cleaned - including rinsing the highly irritating vomitus out of my nose *blech* *ugh*. Once I'm done, the tech lady (who was also the pre-ceptor earlier on), simply pulls my IV out and slaps and (inadequate) gauze dressing on top. I instantly put pressure on the spot, raise my hand about my head and politely ask for two strips of long 1 inch tape. A minute later, I bring my hand down and swiftly pressure tape my IV site dressing down.

"Ok Sir! You're free to go!"

... and that's it. No post procedure teaching. No "discharge instructions". No "discharge sheet". No 'basic' monitoring (like a short set of vitals signs. In fact, no one took my v/s either before or after) after a procedure like that - hell, especially after I showed an adverse (even if it maybe a "common") reaction!

Like I said, there are multiple issues with Radiology that I need to address....


Jaime said...

I hope everything comes out ok, I'm sending good **vibes** your way.

That's the one thing that scares me about nursing, learning the IV's. I'm scared to death of needles (not of shots, just IV's, figures) and hate being poked. But after this last pregnancy it doesn't bother me so much anymore. I had gallstones, gestational diabetes, hyperthyroidism and anemia, so I got stuck alot.

Bravo for helping out the student. I know she appreciated it and will never forget you! Let us know how everything turns out!

X-Ray Geek said...

I love the contrast "blush". Women usually get the heat so bad that they feel like they wet themselves. The vomiting is actually very common. When you shoot that much contrast in that quick it makes a person feel like dog poo. The preceptorship that you describe pretty much sums up most IV training. I learned more from my sister over the phone than I did with actual training. I learned real quick that you don't trust the visible veins and to go for the strong, invisible ones. Being in an x-ray room, the lights are never all the way up. I preferred starting IVs with a slightly dimmed room because I didn't care about seeing the vein. If I could feel it, that was the one I was going for. Hope your scan turned out ok!!!

Anonymous said...

Hope everything turns out ok.

Now when I hit nursing school would you be so kind as to be a guest instructor to teach IV?

Anonymous said...

I'm at CAT scan tech and this narrative is complete BS. Nurses don't know a thing about what we need to accomplish, and frankly I can insert an IV better than any nurse I've seen...we don't have time to wait for IV team to put them in for us. We are very professional where I work. This is a typical nurse's condescending opinion of CAT scan techs. You have no idea of how much knowledge we have...everything you do and then some.

Anonymous said...

Thanks for posting this info. I found it helpful, as I had to have a CT scan on my abdomen and only having to have one on my sinuses before, and so long ago at that, I needed some details of what could or does happen. Although I wanted it to be over when they sent the dye in the line, my scan went okay. I now await the results with much anticipation!