http://goo.gl/Bu1m4a
After several years of chemotherapy, my late friend Monique Doyle Spencer's veins had deteriorated to the point that it was very hard for nurses to insert IV lines. The most painful moments for her would occur when someone would try multiple times to insert a line. She noticed that, if they didn't succeed the first or second time, the process would just get worse and worse as they tried harder and harder. The psychology of the moment was that the person would "anchor" into a certain approach, and the nurse's well intentioned efforts would fall to failure as frustration and anxiety grew--for both parties.
I mentioned this story to my colleague Bijan Teja, a second year surgical resident, who has seen the same phenomenon occur with regard to central line insertions by doctors. He sent the following note:
Please see attached two papers that have shown that the complication rates increase dramatically with more than two failed attempts at central venous line placement. The recommendation is to stop after two or three tries, and usually try a different site, a different operator, or both.
I mentioned this story to my colleague Bijan Teja, a second year surgical resident, who has seen the same phenomenon occur with regard to central line insertions by doctors. He sent the following note:
Please see attached two papers that have shown that the complication rates increase dramatically with more than two failed attempts at central venous line placement. The recommendation is to stop after two or three tries, and usually try a different site, a different operator, or both.