By Michael Tuggy, MD
Several years ago, I was taking care of a young lady, who we will call Becca, who was a 34-year-old with heroin addiction. She had made the transition to Suboxone therapy and had done quite well when we found that she was hepatitis C positive. She had done well on Suboxone with no relapses for over 2 years and she was eligible to have treatment with glecaprevir/pibrentasvir so she saw my hepatologist colleague and completed her treatment course. At the end of her treatment, she needed a blood draw to confirm clearance of hepatitis C.
Becca came to our clinic to get her blood drawn but due to the damage to her veins in her arms and legs, our lab tech was unable to find a vein to get a blood sample. Our lab tech is quite skilled and was very apologetic. She offered to arrange a blood draw at our larger regional clinic about 50 miles away. Becca was okay with going but she felt a bit unsure about going to a new place where no one knew her. Like many people who struggle with addiction, she carried a burden of shame when encountering new clinical team members. She went to get her blood drawn and despite a number of people trying to get blood, including an IV nurse, they were not successful in finding a peripheral vein, including her neck veins.
The next week, I heard what had happened, so I reached out to the patient to check in. Fortunately for me, during my training and occasionally in practice, I had learned several skills that I thought I could apply to her situation to help. During my residency, we performed a lot of central lines, Swan-Ganz catheters, and even femoral lines. I had also learned to use a point-of-care ultrasound to do needle-guided biopsies. I suggested to her that I could very likely get a blood sample from her femoral vein if she wanted to come in for a visit to do that.
When she arrived, I could sense her feelings of shame and I talked with her about how important it was to try not to have that narrative take over – she was doing so well and I wanted her to accept praise for her progress and not focus on her past. She was nervous about the procedure , and I carefully explained what we were going to do to make it as quick and painless as possible. First, I placed the ultrasound on her right groin and we could easily see the femoral artery and the compressible femoral vein just medial to it. I marked the point of entry and mentally set the angle of insertion to drop the tip of my 20-gauge 1-1/2 inch needle into the femoral vein. I first injected a small amount of lidocaine on the surface, then after a minute, advanced the 20-gauge needle an inch into her inguinal space. I had negative pressure on the syringe so that when I hit the vein, I would see the flash and the syringe would fill. It worked perfectly and she barely felt anything. We were done in just a few seconds. I withdrew the needle, filled the specimen tubes for the labs we needed, and held pressure on the site for a few minutes.
It’s those quiet minutes that can make all of the difference. She began to tear up and was so thankful. I told her what a pleasure it was to be able to take care of her and how proud I was of her progress and how happy I was that I could take care of this blood draw for her. We then sat in silence for a few minutes then i placed a bandage on the site and she got up to head out the door. That’s when the big hug came.
As I think back on this encounter, I realize now how important it was for this specific patient that I was able to learn a few skills that helped her in her healing journey in a way that I would never have expected. I am grateful for those senior residents who encouraged me to expand my procedure skills in any way I could. Never stop teaching and learning; you never know when your skills will be needed and how it can touch someone’s life.