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I was so glad to read Dr Yentis's editorial (April 2005 JRSM1), with its message that the pain of venous cannulation is far from trivial. Last year I underwent six cycles of chemotherapy for breast cancer, and thus required six cannulation procedures. Like most patients I feared them— would I get the nurse/doctor who was good at them or would I get the one who jagged a nerve on the first occasion and left me with pins and needles in my hand for six months?—but I endured them with a grimace and a sigh of relief once the things were in. I also knew that PICC and Hickman lines would only be offered as a last resort, even though one of the drugs, epirubicin, is caustic to veins and notorious for making subsequent cannulations more difficult.
True to form, epirubicin seemed to turn my veins to leather or wood; and, because I had had lymph nodes removed, only one arm was suitable for cannulation. The lack of access sites might not have been so serious had I not subsequently developed a brain tumour. This meant a total of five CT, MRI and bone scans within one week, all of which required a cannula. Although the veins were visible, at best several very painful attempts at cannulation were needed and usually I ended up having a paediatric cannula inserted (and I'm no screamer). I asked repeatedly for anaesthetic cream to be applied—Dr Yentis' injection method would, of course, be much quicker—but each time I was studiously ignored. It seemed that the nurses and doctors had decided I was being a wimp and they were going to get the thing into me, come what might.
The only person who actually heard what I said was the sister on the ward where I stayed when I had my brain tumour removed. She applied a local anaesthetic cream and the final CT went like a dream; and the cannula was left in place for the anaesthetist to use the next day.