TTSH vs SGH: Bloods and Plugs

Aye, one of the drone work that house officers do (though it is a very important skill) is that of phlebotomy and gaining of intravenous access. Intravenous (IV) cannulation is a vital skill that determines whether a patient can get IV fluids, inotropic support and antibiotics, all potentially life-saving.

Of course, teams take a myriad of bloods on a regular basis. Full blood count (FBC, aka complete blood count), urea-electrolytes-creatinine (U/E/Cr), liver function tests, anemia workup, calcium-magnesium-phosphate (Ca/Mg/PO), brain natriuretic peptide, coagulation profiles, the list is endless. And let’s not forget the doctor-only bloods: blood aerobic/anaerobic cultures/sensitivities (blood c/s) and arterial blood gases (ABG).

So let’s see… which hospital wins? This is a difficult one, so we’re going to break it down into bloods and plugs.

Bloods.
In TTSH, you have the presence of the friendly phlebotomist. His job consists almost entirely of taking your bloods in the day from 8am-5pm. He/She is also exceedingly skilled, with roughly 1 failure of venous bloodtaking in about 20 days of work (20 days of taking blood from any patient requiring it in 2-3 wards) despite working with renal failure patients. All you have to do is Aurora it (I HATE AURORA).

In SGH, the nurses, believe it or not, can take blood, especially in the medical wards (not so much in the Ortho wards, sorry). And they will approach the doctor only if the bloods fail (or if doctor-only bloods are required). Of course, given that the nurses do everything on top of drawing blood, they do not have the practice of the phlebos and have a higher failure rate.

What about on call? Well, in SGH, there have been multiple times when one has gone to take 6am vanco trough levels only to find that well… the night nurse has already taken it. Even in the Ortho wards! Outstanding.

In TTSH, however, it’s more likely that they call the HO at 2.30am in the morning to take blood for one cardiac enzymes from a man with veins bulging all over the place. The HO walks into the ward to see 1 staff nurse Facebooking, one watching a video, one listening to music, and one writing in the case files (at least one is working).

This is a tough one… so I’m going to call it a slight win for TTSH. This is because when the phlebo takes the blood, there’s an inherent trustworthiness that the bloods will get done. Also, in SGH, one gets called fairly frequently nonetheless (as compared to TTSH’s all the damn time) for bloods… So we’ll say… TTSH wins a split decision.

Plugs.

Sorry, TTSH fans, but this is where SGH finds its second win and beats down TTSH.

Two words: pink plugs.

In TTSH wards, there are generally only two sizes of IV cannulas (i.e. plugs) available: small (23G, blue) and large (18G, green). Whereas in SGH, there are three sizes… including a medium (20G, pink). The problem is that green plugs are friggin’ long, while blue plugs are friggin’ tiny. So if you see a man with thick short veins… you’re stuck with a tiny plug that’s going to leak or a green one that’s going to be sticking half in. The pink plug is a beautiful compromise. Over half the plugs J. used to set in SGH were pink plugs. In TTSH, 90% of the plugs he sets are blue because people just don’t have the veins.

To make matters worse, TTSH is currently in a phase of [hopefully only] testing out a cheaper variety of plugs that frankly suck. They’re not as easy to use, don’t then to stay in place and have a tendency to bump veins. Their cheaper price is negated by their larger quantity of use (higher failure rate in setting, increased failure rate once set). This new plug pisses off HOs, MOs and nurses alike.

Lastly, remember that SGH nurses sometimes help you to draw blood? Well, a good number of them help to set IV cannulas too. The occasional TTSH nurse does too, but these gems of nursing are few and far in between.

In conclusion, although it starts out fairly evenly matched, towards the end SGH overpowers TTSH with some brutal ground and pound to take the round.

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