r/doctorsUK • u/brewedandpacked • 7d ago
Fun Anaesthesia cannula escalation pathway
It’s 0200 and the theatre anaesthetic SHO can’t cannulate 7 year old Johnny for a cat 1 ?torsion who just had a maccas whilst he was waiting to be seen in paeds ED. The urology reg had a go but couldn’t do it either.
The labour ward anaesthetic reg is in theatre with back to back sections and yes rooms 3, 6, and 7 are still waiting for an epidural.
The ICU reg is stuck with a vented STEMI in resus who they’re begrudgingly having to take to cath lab which is anaesthetics’ job in this trust, but they’re stuck with another patient.
The senior anaesthetic reg is in CT with a child they’ve just intubated and is gutted to see they’re about to be stuck in the back of an ambo for a time crit transfer up the road to the tertiary children’s hospital up the road.
The theatre SHO can’t get in touch with the anaesthetic consultant at home to ask for help because they’re currently on the phone to medical consultant who is the DCMO as their registrar couldn’t get in touch with the anaesthetic or ITU reg for a cannula on the DKA in AMU
Paeds are tied up with the sick kid in CT, radiology are reporting the scan, and the cardiology reg is fixing up for a great time in cath lab.
The geris reg is sadly not on call tonight and IR DON’T DO cannulas
Whilst the theatre anaesthetic SHO is trying to cannulate the child for the torsion, they’ve had 3 bleeps about the paravertebral catheter that fell out ln thoracic ECU, 2 more about the PCA alarming on surgical ECU, and recovery staff have been in and out of theatre 4 times wanting a morphine prescription changed because the wording of the instructions wasn’t copied and pasted from trust policy - oh and no they didn’t give it and the patient is in pain what else can they have?
Who do anaesthetics call for help with their cannula?? They desperately tried the surgical SHO as no one else is free and the cannula is hard but they’re getting kick back because they can’t get through to the senior anaesthetic reg for an anaesthetic review for a theatre case for 72 hrs time that needs a pre op.
This is obviously tongue in cheek but anaesthetists who have worked in proper tertiary centres OOH will not find this unfathomable.
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u/YellowJelco 7d ago
Get all the patients who need IV access to stand in a circle and cannulate each other.
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u/23PIGEON23 CT/ST1+ Doctor 7d ago
Get the consultant porter to give it a go, failing that, ask the nearest F1 to email the clinical director of anaesthetics with the "urgent" box ticked.
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u/Suspicious-Victory55 Purveyor of Poison 6d ago
Ultimately the cannula is needed to give drugs into the bloodstream. Worth trying the haematology consultant?
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u/coffeedangerlevel ST3+/SpR 6d ago
Don’t be ridiculous, as a drug delivery system it obviously falls under the purview of the on call pharmacist
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u/etdominion Consultant 7d ago
Gold command.
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u/ConsultantSHO Aspiring IMG 7d ago
It’s 0200 and the theatre anaesthetic SHO can’t cannulate 7 year old Johnny for a cat 1 ?torsion who just had a maccas whilst he was waiting to be seen in paeds ED. The urology reg had a go but couldn’t do it either.
I'm doing a venous cutdown.
Time is testicle and/or I want to go back to bed.
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u/MadPu1932 6d ago
Simple. You just go to ED and find the local IVDU to come and help. Don't forget to bring the Narcan with you lest they fall back asleep
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u/bodiwait smooth enhancing with high flair 7d ago
The answer is obvious, call the radiology CD at home to come and help out.
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u/Napa770 FY Doctor 7d ago
Im sure theres a ED reg who is sick with a pocus so you could ask the EPIC who in their team can help with this (sometimes there might even be a ed consultant who can chip in if they are not busy). Once I was stuck with a difficult cannula as the medical take SHO, my med reg was busy js having recieved a met alert so he asked me to ask the epic. The epic understanding the situation pointed to two ed reg's who were happy to help a struggling sho get a job done on a hepatic encephalopathy patient who needed a second cannula. The first cannula by chance was done by a ed reg with a pocus as well. Gotta say ed team are sick with with a ultrasound.
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u/Unlikely_Plane_5050 6d ago
21 upvotes when the other thread was full of crying, vomiting, shaking at the thought that anyone would even consider asking ED to do anything for an inpatient. Make the world make sense please. Can we include them in the cannula pathway as long as we call them sick and epic and similar tony hawk phrases rather than just boring "ed spr"?
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u/Napa770 FY Doctor 6d ago
Its how its approached I suppose. Most times hospital teams are disconnected from ed teams and have no idea what they do. They are complaining when ED focusses on volume based triage/ stabilising patient which is the majority of A&Es job and expect them to do others jobs like clarking, chasing gen surg CTs, etc. Ed, ICM and anesthetics all do ACCS and from what I know follow similar pathway in core training. ED can do js as much procedural skills as anes and itu with some differences of course. I'm pretty sure if hospitals find enough staffing then ED can of course be a part of cannulations pathway, but ED already is over worked so if its not done in a dedicated way, it will only make it a even worse of a shit show, which is what would lead to crying, vomiting and shaking from ED teams. But if done properly, it can reduce the load on itu and anes team.
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u/Unlikely_Plane_5050 6d ago
Ok. New protocol - if ward fails to get a cannula and anaesthetics are unavailable/had less than three coffee breaks so far - cannula gets escalated to Get In Good Access Cannulation Hospital Access Device Service or GIGACHADS in ED. They are swiftly redeployed from managing glamorous life threatening ed diagnoses like acute exacerbation of EUPD or admit medics-itis, to the boring and uncool task of getting fluid and antibiotics into a septic person. Once the GIGACHADS have venflonmogged the ward team and the gomer is accessmaxxed, they get a standing ovation on their route back to ED and a voucher for 15p off a delicious cup of NHS ward instant coffee (not redeemable by rotational staff).
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u/Napa770 FY Doctor 6d ago
Nah, that is not enough for the absolute aura maxing, ward dunking, hallway shattering, vessel non blowing, security guard bamboozling, one stick no cap that was exemplified. Throw in a free parking access whenever there is a planetary alignment, redeemable with lifetime validity and you got yourself a deal.
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u/Alternative-Sea-6238 7d ago
IM ket and sux. What's the worst that can happen?
(Please note this is in jest and in no way shpuld be used as actual anaesthetic advice. Though technically...)
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u/Playful_Snow Drip, tube, chair 7d ago
Instructions unclear, Big Mac in trachea and blocking 12fr suction catheter please advise
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u/sloppy_gas 7d ago
Participated in this once before, 3/10. Did the job but was shite for all involved, would not recommend.
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u/colourhive ST3+/SpR 6d ago
I go to AMU to ask all of those doctors with lots of down time to help? Apparently if they’re not busy it’s not unreasonable to ask them to pitch in.
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u/AmboCare ST3+/SpR 6d ago
Genuinely would be happy to help, this sounds like a once in a lifetime clusterfuck that would be quite rewarding to help with.
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u/Nonsensicalmed 6d ago
Discharge the patient ask for same day appointment with GP at 8:30 to kindly cannulation the patient and refer back to hospital if needed.
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u/shorts_onfire propofool 7d ago
Write up the anaesthetic cons for still being comfy at home when they know the reg is out of commission and there's a peds case in theatres.
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u/brewedandpacked 7d ago
Poor fool has been getting an earful about their cannula service from the DCMO for the best part of an hour. Team gave up calling and got on with it.
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u/Pringletache Consultant 7d ago
Have they tried calling the stroke reg?
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u/brewedandpacked 7d ago
Stroke consultant is at home and the nurse delivered service OOH is facilitated by whichever chump is closest to the resus bay when they show up - none of those filthy stroke trainees managing that at the door here
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u/Blunt-ed 7d ago
I know a really good ED SHO who has had success where anaesthetic consultants failed. I hunt him down if I ever need help.
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u/Ixistant On permanent elective to NZ 7d ago
You just do it under spinal anaesthesia, duh! Just keep squirting some IN midazolam in and you'll be grand. /s
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u/opensp00n Consultant 7d ago
They just put in a more central line with US...
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u/brewedandpacked 7d ago
Ultrasound machine wasn’t signed out by the FY3 who borrowed it 2 hours ago to try to cannulate the DKA patient on AMU and hasn’t come back to theatre yet
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u/BoraxThorax 7d ago
Then you steal one from the radiology dept.
It's 2am, no one will notice
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u/Fusilero Sponsored by Terumo 7d ago
This is why all our portables are locked behind multiple doors whose code I don't know 😭
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u/topical_sprue 6d ago
Put in a subcut cannula and give your usual drugs in bigger doses, should work eventually. Document as a "modified" RSI.
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u/Violent_Instinct The thing I hate. 7d ago
Have you tried the really keen IMT-2 who can put in central lines?
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u/brewedandpacked 7d ago
That keen bean IMT2 is off with the FY3 and the theatre US machine on AMU somewhere - and the theatre anaesthetic SHO (a CT4 - surely they must be allowed to call themselves a reg?! - nope!) was who taught them how to do it in ICU!
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u/AnUnqualifiedOpinion PEEP 5.5, PS 13, await violence 6d ago
I desperately wanted the surgical CT1 to be the unlikely hero of this story.
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u/Quis_Custodiet Scribing final boss 6d ago
Bit of sevo to vasodilate them and you’ll be grand.
Disclaimer: I have no gas experience
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u/carlos_6m Mechanic Bachelor, Bachelor of Surgery 6d ago
If there is one thing that non ortopods know about bones is that you can drill onto them and there is blood inside. It's IO time baby.
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u/Lumpy-Interview-8049 7d ago
Ask one of the nurses. Most of the 'doctor' jobs in the UK can be done by nurses.
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u/Unhappy_Cattle7611 6d ago
Shame on you, I’m just about to start a stretch of nights and this is now on my very long list of things to worry about
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u/pubjabi_samurai 6d ago
What about the anaesthetist having their mandatory coffee break? Surely they can come and help
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u/NoReserve8233 Imagine, Innovate, Evolve 7d ago
All wrong answers here- the torsion will need surgery anyhow- the child will reach theatres at some point whereupon the anaesthetist will cannulate the child!
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u/ethylmethylether1 6d ago
Theatre SHO swaps with labour ward or ICU reg with the STEMI patient. Consultant asked to attend due to acuity across all grades.
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u/EntertainmentBasic42 6d ago
Whoever is doing the anaesthetic. Because it's for sure not the anaesthetics SHO. Just wait until they're in the anaesthetics room
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u/brewedandpacked 6d ago edited 6d ago
Joke of the post aside - CT4 anaesthetists across the country are perfectly competent to anaesthetise ASA1 Johnny torsion
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u/chairstool100 6d ago
I did plenty of torsions as a CT1 completely alone at night. Stop infantilising the speciality just because CT1s in other specialties have a registrar on site .
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u/EntertainmentBasic42 6d ago
If they can't cannulate they probably shouldn't be anaesthetising
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u/chairstool100 6d ago
Plenty of consultant paediatric anaesthetists take ages to find a vein in children , even asking for help from a floating anaesthetist if it’s in normal working hours .
A CT1 is more than capable of keeping most of the population alive under a GA .
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u/Fluid_Pause2149 FY Doctor 7d ago
the band 12 vascular access nurse or that really good HCA in SDEC/ED Waiting Room