RickInOz

Is becoming indispensable. At work it helps having a skill, ability or sphere of knowledge that is rare amongst your colleagues. One of our consultants can perform echocardiography, and is very valuable if we have a patient with impaired cardiac function.

My latest talent is the inertion of peripherally inserted central venous catheters (PICC). These are 50 cm long lines that are placed in a patient’s elbow and travels through the venous system so the tip lies in one of the major veins in their chest. This allows for the administration of antibiotics, chemotherapy or intravenous nutrition. Another advantage is that a PICC line can remain in situ for up to 3 months whereas simple peripheral cannulae only work for a few days and centrally placed catheters have to be removed within two weeks to minimise the risk of septicaemia.

The technique is quite straightforward but requires the ability to site needles under ultrasound guidance competently. It requires aiming for a vein only 5mm across from up to 5cm away. This is the complex part of the line placement, as once the vein has been obtained, the remainder usually proceeds smoothly. So far few of my colleagues feel confident doing these lines, and fewer still without supervision. As with many technical skills, much of the expertise comes not from knowing how to actually perform them, but how to troubleshoot if things don’t go as planned. There are many little tips and tricks that I’ve gained through research and hands-on trial and error to achieve the end result.

With time I’m sure everyone else will learn how to do these too – after all, if I can do them then it can’t be too difficult. In the meantime it’s nice to be useful!