I got to perform several more intravenous therapy (IVT) injections giving me more opportunities to practice my needle skills. I've learned the best way to avoid air bubbles is to slowly pull the needle out of the injection vial as you load the syringe. Doing this keeps the needle submerged in liquid the entire time your pulling back on the plunger. It's a small easy step that cuts loading time (for me at least) in half. It also helps you use the medication efficiently because you're wasting less of it since you don't have to keep ejecting air pockets. You know how in the movies when someone is about to give an injection they push the plunger down until a bit of the medication squirts out? It's true, that does happen, but only if you're not a well practiced nurse. For example, when I load syringes, I have to squirt a bit of medication. However, the nurses here have performed countless injections and are always short on medication so they've perfected the art of loading syringes. They can load medication right up to the beginning of the needle with zero air bubbles and no loss of medication.
I also assisted with an NGT insertion because a patient came in who had suffered stroke. It was kind of unsettling because, although the patient was in a semi-stupor, she could still move and was struggling as the tube was inserted through her nose. I asked the doctor how she could tell she wasn't inserting the tube into the lungs and she told me, with patients that can still swallow, it's easy – just tell them to swallow and the body automatically closes the nasopharynx cutting off access to the lungs. You can try it yourself. Swallow, and during mid swallow try to breath through your nose. If the patient cannot swallow, then it's trial and error. However, the doctor told me that, with practice, you can just feel that you've entered the lungs. She also told me how, normally, you're supposed to measure the tube before placing it in the patient, but they don't practice that here because the measuring it first increases the risk of infection. The risk of infection is greater than the doctor placing the tube too deep – that's how clinically skilled the medical staff is here. I had to look up on the internet how to measure the NGT tube and it requires starting that the patients nose, looping it around the ears, and measuring approximately 5cm below the xyphoid process. The doctor here used sterile procedures (including sterilized surgical gloves) and when the patient was brought in, she was anything but sterile. So I definitely understand why the doctors don't want to dangle a sterile tube around the patients ears and nose right before inserting it directly into their stomach.
The staff here has told me how I'll be able to do an IV insertion at some point. Because there is only one doctor on staff, the nurses here all know how to insert IV's. Although IV insertions require training and certification, most of the nurses here just received on the job training. If the doctor or certified persons were to do all the insertions, there would literally be no time in the day for anything else – that's how often IV's are used here. I expressed how I was nervous about it and I the charge nurse gave me some of the best and most practical advice I've been given thus far in terms of practicing medicine. I'll paraphrase:
Trust yourself. Be confident. Choosing medicine as a career is already proof that you want to help others, so don't think that learning skills will harm the patient. If you don't give an IV because you're too scared of hurting them, then the patient will never get better. You'll make mistakes, and if you truly want to be here, then you'll learn from them.
Anyway, I'm enjoying my time in the ward. It's a little bit more routine, but I get to practice needlework more often and am exposed to a lot of clinical skills that I'll have to master if I want to become an effective PA. I'll leave you with a picture of me about to load a syringe.
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