Taking the sting out of needles

Abstract

I cannot, unfortunately, claim to be the wise mentor who taught Dr Yentis the seven principles of ensuring painless venous cannulation (April 2005 JRSM1): I can, however, claim that from 1978 I was teaching cohorts of medical students and anaesthetic novices the importance of using local anaesthesia before cannulation in conscious patients. Of the reasons he puts forward for why doctors do not do what is known to work I suspect the third is correct: they accept the evidence but choose to disregard it. This is well summed up in the old adage 'That's a good idea: we won't implement it'. Other examples could be quoted. Before drugs such as ranitidine were introduced into obstetric anaesthesia it was often recommended that the patient's stomach should be emptied before inducing general anaesthesia. Holdsworth2 showed, somewhat surprisingly, that vomiting induced by apomorphine injection was considered much pleasanter by patients than the passage of a stomach tube. The two methods were equally effective and apomorphine had no deleterious effect on the baby. Nevertheless, the use of apomorphine was never widely accepted. Nott and Hughes3 showed that the use of an intranasal spray of lignocaine significantly reduced the discomfort caused by insertion of a nasogastric tube, but as far as I am aware this simple manoeuvre has not been universally adopted. Patients remember staff who are kind and procedures that are painful or distressing. Wards and clinics provide a rich source of simple research projects that could enhance the comfort of patients and the CVs of doctors.