Sunday, September 11, 2011

Branula Insertion for Geniuses

Everytime I poke my patients for branula insertion, I thought of doing this entry but proscination is my good friend. Forgive me :)

This entry is especially for my junior colleagues and medical students. A simple sharing from a humble house officer.
My daisy path today said "I've been a doctor for 1 year, 3 months, 2 weeks and 1 day". So perhaps I poke hundreds of patients in my career to enable me to make this entry :p

Branula insertion for dummies geniuses.
  • Look for a suitable vein. Always start with the most distal before migrate upward to avoid from having to deal with thrombosis.
  • Avoid from using veins near the joint as much as possible, because it cause discomfort to the patient. You don't want to make him suffer more.
  • Always use glove.
  • Have a good torniquet.
  • Measure the length of your needle before you go in.
  • Use straight vein for obvious reason - your needle is straight.
  • One of the most important tip for any successful procedure in paeds, make sure you immobilize the patient as much as you could. Use plain cloth to "bedung" them, ask your colleagues, staff nurses, student nurses or sometimes when everyone is busy, the father (instead of the mother) to hold the child's body and elbow joint. Or any involved joints.
  • Don't touch the tip with your finger, that area is strerile. Branula insertion is suppose to be a sterile procedure.
  • Warn the patient, or your assistants who help you to hold the patient when you are about to go in. "Saya cucuk ye makcik", "pegang kuat-kuat ye dik".
  • Important! When you see a back flow of blood when you advance your needle, don't immediately pull your needle out. The line will easily bunk if you do so. Advance it a few milimeter more before you start to pull. This, perhaps is the most important fact that I've learned after inserting it to hundreds of patients.
  • Secure, secure and secure your cannula with good plaster.
  • Always use splint for paeds who are young enough to cooperate. You don't want to poke the same patient over and over while the mother waiting outside crying.
  • If you fail, especially in paeds, always ask for help. Especially if the patient is really sick or in need of antibiotic. Your colleagues, MOs, even some staff nurses are good enough with branula insertion.
  • In adults, if peripheral veins fail you could go to femoral or neck. In paeds, scalp vein is an option. But those are quite extremes. If still fail, CVL long line is an option.
  • If the patient is well enough and the branula just bunk? Maybe you don't need to poke him anymore. Just ask them to drink lots of water to replace the IV drip or change the antibiotic to oral.
I was never good with branula insertion when I was a medical student. I started my career with inserting lots to pregnant women who have the best veins you could ever wish for. Then progressed to ordinary patients in gynae, medical. Progressed further to old patients in medical with running, tiny veins. Challenged further with ESRF, anasarca patients with swelling all over and IVDU patients with collapsed veins. In surgical oncology ward with patients who had multiple chemo that damaged their veins in need for another IV access for the next cycle. Now in paeds with patients having tiniest veins in the world. Practice makes perfect. If I can do it, so can you.

To have the knowledge is one thing, to acquire the skill is another thing in the path to become a successful doctor.

All the best!


  1. hye....know what, i love this procedure, most of the houseman and MO in Emergency department believe me in branula insertion. ^_^

  2. It was my very painfull moment.lots of branula insertation in my kids and teenager time.

  3. Salam..thanx for sharing..this procedure requires more practices to master.. =)

  4. My princess had her 4th branula insertion in 8 days. Lucky mama was strong enough to handle this situation