Tuesday, December 30, 2008

Newly Graduated AND Employed Medical Assistant!

As of Monday, December 29th I am no longer a "Student" Medical Assistant -- I am a graduated AND gainfully employed Medical Assistant!

I am over-the-moon thrilled at continuing on at the same practice I completed my externship at. I became sad at the thought of not being able to stay there because I became attached to a number of amazing patients -- and they have become attached to me, too.

With the exception of the Office Manager (as far as I know anyway), I was the only other employee with the knowledge that there was a good possibility I would be asked to join the practice after my externship was over. I didn't even tell the patients I was working with. Even after they expressed their disappointment if I became employed elsewhere. That was tough to do, too!

Today I performed a wound care on a delightful 80-something year old woman. In the short span of three days, approximately two weeks ago, she was involved in an automobile accident (she was driving, totaled her van and received a black eye and a cut on her eyebrow) then she slipped and fell in her kitchen and scraped up both of her shins in ways you cannot begin to imagine.

I assisted the physician in removing both of her leg bandages to confirm everything was healing properly and that there was no infection present. Thanks to daily home health care, they are healing beautifully and there is currently no sign of infection.

She also scraped up one of her wrists but I cannot remember if that was from the auto accident or the slip and fall.

Today I learned another venipuncture technique -- drawing blood from a patient's foot. This patient was a retired LPN and when I entered the exam room to draw her blood she let me know right away that she was a difficult draw. She was NOT exaggerating! Her veins teeny tiny AND could not be palpated at least locate even if we could not see them.

I hear that a lot from patients -- "I'm a difficult draw". I instantly think, inside my head of course, "I LOVE a challenge"! Nine times out of ten (in my head, of course!) I prove the patient wrong. Several times I have been either the ONLY MA in our office, or the only OTHER MA in our office do a successful draw in ONE poke.

I almost exclusively use a "butterfly" needle when drawing blood. Mostly because the needle is smaller in diameter, shorter in length and easier to manipulate if a vein "rolls" and I need to reposition it within the patient's arm.

I like the "butterfly" needle so much so that I tell my patients it's my "Magic" needle. I try to time the delivery of that information to occur just before I insert the needle into the patient's arm. As the patient ponders on how a needle could possibly be "Magic", I'm in and out of their vein.

Almost every single time I use my "Magic" needle the first thing the patient says when I've removed the needle from their arm is "That didn't hurt a bit!" I flash them a cheesy, dimpled smile and tell them "That's my "Magic" needle!"

The "Magic" needle is not the only distraction technique I employ when drawing blood. Because the "butterfly" needle is so low-profile, I come in low on the vein. Other MAs come in high on the vein.

Here's the difference.

Coming in Low: Holding the "butterfly" between my thumb and first finger, I make sure that the rest of the hand (palm and three fingers) I'm holding the needle in is lightly resting on the patient's arm. Although I do this to steady my hand, I have found it is also a simple distraction for the patient. Because I have positioned the needle to be as close to parallel as possible to the arm, I allow my thumb and finger to softly drag across the patient's skin as I head for the vein. Instead of concentrating solely on the "poke" to come, they feel the warmth of my hand and the slight pressure of my fingers on their arm while they're pondering how a needle can be "Magic". :-)

Coming in High: I saw this a lot in school. It's not an "incorrect" way by any means, it is just my personal opinion that it is much more painful for the patient. Instead of resting your hands and fingers on the patient's arm, typically only the pinkie finger of the hand holding the "butterfly" makes contact with the patient's skin. The needle is typically positioned at a 20 to 30 degree angle.

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