When I started my ED rotation, I was genuinely anxious about putting in an IV line.
Like many junior doctors, I wasn’t particularly confident with cannulation. Every difficult patient made me nervous, and I knew that success mostly came down to experience.
Fortunately, over the next few months, I had plenty of opportunities to practise. With every shift, my confidence improved.
Ironically, once I became more comfortable, I started receiving phone calls while covering the medical wards.
“We’ve got a patient with difficult IV access. The nurses have already tried. Can you come and have a look?”
If you’ve worked on the wards, you’ll probably recognise this situation.
The nursing staff are incredibly experienced at cannulation. They often perform many more cannulations than junior doctors ever do. If they have already tried several times without success, there is a good chance you won’t succeed using exactly the same technique.
That is where ultrasound becomes invaluable.
Why Every Junior Doctor Should Learn Ultrasound
Many hospitals now have portable ultrasound machines readily available. Some are even handheld devices that connect directly to a smartphone or tablet.
I genuinely believe ultrasound is becoming the modern stethoscope.
Being able to visualise the vein before attempting cannulation completely changes your approach. Instead of relying on palpation and guesswork, you can identify deeper veins, assess their size, and choose the best target.
For patients with obesity, oedema, chronic illness, or a long history of hospital admissions, ultrasound guided cannulation can make all the difference.
The Best Place to Learn
For me, the best place to learn was the Emergency Department.
Most Australian EDs have excellent ultrasound equipment, and more importantly, consultants who are enthusiastic about teaching.
During my rotation, our consultants regularly ran teaching sessions on ultrasound guided cannulation. After attending these sessions, I practised under direct supervision until I became comfortable performing the procedure independently.
That supervised practice made all the difference.
Reading about ultrasound is helpful, but nothing replaces holding the probe, coordinating your hand movements, and developing the muscle memory required to perform the procedure smoothly.
Ultrasound Is a Practical Skill
The biggest challenge is not understanding the theory.
It is learning how to interpret the image while coordinating your hands.
At first, even simple movements can feel confusing. Rotating the probe, adjusting the angle, advancing the needle, and keeping the tip in view all require practice.
The only way to improve is repetition.
Practice, practice, and then practice some more.
Eventually, the hand eye coordination becomes natural.
Beyond Cannulation
Once I became comfortable using ultrasound for IV access, I wanted to learn more.
That led me to EFAST.
I attended an RACGP ultrasound course, which was excellent, although I have to admit it was expensive.
(To be fair, almost every medical course in Australia is expensive, so whenever you attend one, make sure you absorb as much as you possibly can.)
One of the best resources I discovered during the course was Core Ultrasound. Link: https://coreultrasound.com/
It is not a guideline but an outstanding educational resource.
The lessons are concise, practical, and organised logically. They explain the different probes, how each one is used, how to obtain the correct views, and what normal and abnormal findings look like. The short videos make it easy to revisit concepts whenever you need a refresher.
My Advice
If your hospital has an ultrasound machine, use it.
Ask your senior doctors if you can practise under supervision.
With the patient’s consent, scan normal anatomy. Look at the liver, spleen, kidneys, bladder, heart, and the common EFAST windows. The more normal scans you perform, the easier it becomes to recognise abnormal findings later.
Don’t wait until you are expected to perform an emergency scan before picking up the probe.
Ultrasound is a skill built through repetition.
Learn the basics from experienced clinicians.
Use high quality educational resources.
Then keep practising whenever the opportunity arises.
I truly believe that bedside ultrasound will become an essential skill for every junior doctor over the next decade, just as the stethoscope became an indispensable part of medicine many years ago.
Leave a Reply