Performing procedures and avoiding errors

[badasshairday]

Obviously in IR their are many procedures. How do you thing about procedures. Do you plan it out in your mind and think of all the steps? I am just wondering how I can start thinking about complex multistep procedures starting now... Especially after botching a simple intramuscular injection today, lol. And I will be doing an IR rotation in a few months as well. They expect medical students to show competence in basic venous access procedures (PICC lines, ports).

I think the lesson I learned today is that if it something doesn't seem right, ask for help. Sort of killed my confidence, despite hitting many simple procedures such as IM shots, IV placements, removing/placing staples and more complex ones like suturing, intubations, etc so far in my third year of med school. But one mistake always makes you forget all the ones you got right! Worries me that I could possibly screw up inside somones vasculature with wires/catheters in them!

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[Raygun77]

what went wrong with your IM injection?

Not to make you ruminate but maybe it's something we can all learn from.

in terms of answering you, i guess i'll keep it simple and say have an inclusive process/mental checklist and get lots of practice....

 

[IRneuroIR]

Two things here:

We all make mistakes but the key is to identify what went wrong and figure out how to avoid it next time. I agree with Raygun77 -- maybe we can all learn something from your experience if you don't mind sharing.

Yes, employ a mental checklist when performing any procedure -- even those that seem "very easy". Even when I place PICC lines and medports, I go through my checklist before I start and keep in mind what may be unique about the patient's condition (elevated INR/coags, low platelets, heparin allergy, etc.). This is even more useful when tackling more complex cases such as cerebral aneurysm coiling or transarterial embolization. Finally, practice makes perfect (or nearly so) -- once you've done 1000 PICC line placements, the steps and the use of a checklist will be engrained to a point of being instinctive.

 

[badasshairday]

Not really much to learn from my experience, it was just an IM injection to the deltoid on a more sensitive patient, who recieves shots in her deltoid every 3 months. Also the maximum most people give in the delts IM is 1.0cc, I had to administer a 1.5cc med... would have been better to do in the glut.

 

[IRneuroIR]

Well, even in your scenario there is something for us to learn/remember and I'm sure there is someone out there who didn't know this.