Vampire at Night

December 19, 2019

I saw this post in my draft, just the picture below.

I bet this post was drafted when I was in medical posting (at least a year ago).

Usually only in medical posting, we have huge number of bloods to be taken before 6am for a night shift houseman. Honestly, the process of blood taking is not that long (it can be as short as 1minute) ONLY IF:
- the patient is cooperative, 
- the patient does not have any chronic kidney disease / on chemotherapy,
- the patient is not obese,
- the patient is not dehydrated,
- the patient is not a kid or elderly,
- the person doing the blood taking has good experiences.

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The are two ways to take blood - from venous and from artery (in Malay, we call artery as nadi - the pulsating one). 

For difficult blood taking, somehow taking blood from artery will be the best way instead. Just, I believe it is painful compared to via venous, but only arterial blood can give the best result to see the good is our oxygenation in our blood system. 

Few problems you can encounter during blood taking (venipuncture) / branula insertion:

1. Delicate / running veins
  • Usually these can be seen in elderly
  • Our veins are elastic - the moment a needle is inserted into the vein, our vein will hold the needle in place (like... hugging the needle) - there will be no way for blood to escape - like a seal. 
  • But for elderly, their veins are less elastic --> hence, blood will slowly go out in from the hole in between needle and vein, leading to hematoma. 

2. Neonates
  • I believe many of us have seen the current issue about blood taking in baby.
  • It is difficult to be honest - you need steady hands and at least one assistant. Usually taking blood from neonates without assistance is doable, if you cover the other limbs nicely and know how to retract the skin well to properly expose the veins beneath.
  • But, to insert branula to a baby can never be done alone. Trust me, I have tried once, the branula was successfully inserted (just the way for blood taking is done), but the secure the branula will be another issue. Assistant is obviously needed to secure the branula on the baby's hands.

Gebu gebas

3. Advanced kidney problem
  • Especially patients on regular dialysis. 
  • In these patients, the blood vessels will slowly constrict (smaller diameter) --> hence the difficulties.
  • They also will have one side of upper limb with fistula / prepared for future fistula, so we lost chance to take blood from one limb. 
  • Don't ever poke patient on the same side of limb with fistula - we are going to risk the pathway for him to do dialysis later by introducing injury / infection. 

There are lots of more actually, you can further read about difficult blood taking here. I believe I have encounter almost all difficulties as shared in the link.

Not to mention, other situations to be taken into account - like, patients pergi mandi/solat/toilet, nak kejut patient dulu untuk bangun tidur, nanti ha terkejut tiba-tiba kena cucuk.

blood taking trolley

I must say, blood taking / branula insertion is surely painful. But, reminds ourselves that blood is like our identity, it reflects the condition of our body - is the water enough? is the kidney / liver okay? is the blood sending good amount of oxygen? is there any infection - is it bacterial / viral?

So many things can be checked from the blood. Blood is precious. But don't worry much if you think doctors are taking lots of blood, we at least have around 4500 - 5500ml of blood in our body and usually the maximum amount taken daily is maybe 10ml - it is like 0.2% only hehe :)

SM, Perak

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