The Art of Cannulation

I love my rugby! And no, I didn't just lure into this blog to make that random confession. The reason I bring up rugby is because as I was watching the grand final on the weekend, I started to wonder why the goal kickers go through their very precise and deliberate routine each time before kicking for goal. If you don't know what I'm talking about, have a look at the Chiefs goal kicker Damian McKenzie:

Why the heck does he smile just before he's about to kick the ball!? Surely that's not in your standard goal kicking training. But...it works! For him, that is. If someone asked me to go out on the field and kick a goal from 50m out and told me "just smile before you kick the ball and you'll be fine", I don't think I'd have much luck.

But, I bet Damian McKenzie couldn't lob a 20G cannula in someone's cubital vein, so I'm one-up on him there.

So what is the difference between a goal kicker who can kick 10 out of 10 goals and someone who only kicks 2 out of 10? Or to put that into a more relevant question, what is the difference between a radiographer who can cannulate 10 out of 10 patients and someone who misses 8 out of 10 times? See what I did there ;)

Well, the first thing is EXPERIENCE. Practice makes perfect, whether its cannulating, goal kicking or doing your tax return. The only way you can get to a place where you rarely make mistakes is by making the mistakes in the first place (probably more than once or twice). If you're not learning from your mistakes, then you've wasted an opportunity. Every time I miss a cannulation I ask myself "why did that happen?" Did I aim for a vein that I couldn't feel properly? Perhaps I should have taken more time to find a better vein. Did I approach it from the wrong angle or did I advance too far (or not far enough)? Maybe I should change my technique slightly.

The second key difference is ROUTINE. The human brain is amazing. It is basically a biological super computer that processes all of our current experiences, and packages them up and stores them into parcels of past experiences. By developing a routine when performing technically difficult or precise tasks, we are effectively forging an algorithmic shortcut to draw from these past experiences. Think of it as loading a computer program using cache - rather than loading the entire program from scratch, we're storing most of the data in a separate file ready to be used. It kick starts the process much more quickly and effectively.

That is why we are seeing so many athletes form these weird and wonderful routines, and I think there is something to take from this. Form a routine with your cannulation (probably not a creepy smile like Damian McKenzie, though!). This has probably already happened to some degree without you realising it...I know it has for me. I rest my foot on the sharps bin trolley every time I dispose of the sharp, and it took a colleague to ask me about it one day before I even realised I did it!

Forming a routine means you are less likely to forget any steps, such as having all of your equipment laid out ready to go, or making sure the sharps bin is within arm's length. I had a colleague the other week forget to do the latter, and as they were stretching to get to the sharps bin, blood was pooling out of the cannula. In a hurry to get the valve on, they forgot to secure it tightly, so as the contrast was injected it leaked EVERYWHERE. That set us back about 15 minutes, all because the sharps bin as 2 feet from where it should have been.

So there are my two cents on cannulation. While it is a technical skill with certain do's and dont's, it can also be an art form - learn from your past experiences and mistakes to develop a precise and well-practised routine, and in no time you'll have a 100% strike rate.