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ANESTHESIA ALERT
relax your patient and begin to instill confidence? For starters, I find
that taking the extra time to "set the scene" goes a long way. I start by
introducing myself, and I call the patient by name. Establishing a rapport can help you identify fear or anxiety that may cause patients to
tense up and make for a more difficult start. I also always answer
their questions, but I'm careful not to tell them more than they want
to hear.
Body mechanics
Once you've established a rapport with the patient, it's time to get that
patient into the best possible position. These are the body mechanics
to strive for:
• Keep the head of the bed low. Raise the whole bed to a comfortable
height for you, and help your patient settle in and relax by keeping the
head of the bed relatively low — a 20° to 30° angle. This makes for better blood flow to the vein and also keeps you from having to bend over
the patient. Consistently using this position will help you get used to
holding and inserting your catheter at the same angle.
• Ask the patient not to watch. Explain that if he lifts his head to look,
he'll automatically retract his arm and move it, which can cause you
to lose your insertion site.
• Give yourself room to work. Have the patient slide over to the railing
on the far side away from you. That will create more room for the arm
you're working on to relax and lie flat on the bed. That stabilizes the
arm, which works better than if the arm is hanging off the edge of the
bed. The goal is to be able to position yourself distally to the vein and
keep the catheter aligned with the vein.
If the patient has to sit up in a chair, use a stool or crouch down.
Sitting places you closer to the level of the vein and helps prevent you
from inserting the catheter too deeply. (You can see this for yourself if
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2013
