Last Wednesday was my first time volunteering at Derriford Hospital. I was assigned to the Mayflower ward; this specialises in renal medicine so has on it both pre and post-transplant patients as well as dialysis patients. This week I was able to shadow some of the junior doctors on the ward, thus providing me with insight in to the life and jobs of an foundation year 1 doctor. The particular doctor I shadowed allowed me to witness two minor procedures during my afternoon on the ward. Firstly, I was show a patient having blood taken to be placed in blood culture bottles proceeding a persistent fever. When a patient shows signs or symptoms of a systemic infection, results from a blood culture can verify that an infection is present, and they can identify the type (or types) of microorganism that is responsible for the infection. However, negative cultures don’t exclude the possibility of infection. I walked the blood culture to the microbiology department where the
bottles are entered into a blood culture machine, which incubate the specimens at body temperature. The blood culture instrument reports positive blood cultures (cultures with bacteria present, thus indicating the patient is “bacteremic”). Most cultures are monitored for 5 days after which negative vials are removed. If a vial is positive, a microbiologist will perform a Gram Stain on the blood for a rapid, general ID of the bacteria, which they will report to the attending physician of the bacteremic patient. Gram staining is a differential staining technique that differentiates bacteria into two groups: gram-positives and gram-negatives. The procedure is based on the ability of micro-organisms to retain colour of the stains used during the gram stain reaction. Gram-negative bacteria are decolourised by the alcohol, losing the colour of the primary stain, purple. Gram-positive bacteria are not decolourised by alcohol and will remain as purple.
The second procedure I was able to watch was the insertion of a catheter to a male patient. The junior doctor allowed me to aid him in maintaining the sterile conditions needed for the placement of the apparatus used. Essentially I opened the packages of all the equipment, including the catheter bad, catheter and water vials. I was surprised at the level of necessity of maintaining the sterile conditions. This also gave me the opportunity to see how a doctor reacts to a patient in evident discomfort. Simple reassurance and an omission of confidence seemed to prove effective in calming the patient.
In this case long term catheterisation was necessary due to the weakness of the patient proceeding a transplant, consequently and indwelling catheter was utilised. This is where the catheter remains in place for many days or weeks and is held in position by a water-filled balloon in the bladder Many people prefer to use an indwelling catheter because it is more convenient. However, indwelling catheters can be complicated by problems such as bladder spasm, infection, blockage and leakage around the catheter. These problems are reduced if intermittent catheterisation is used.