back to article Need a needle in an artery? Move over, doc, there's an app for that

Research published in the Canadian Medical Association Journal (CMAJ) has shown a smartphone application is superior to traditional physical examination for spotting when it is safe to stick a needle into an artery. Researchers used an elderly iPhone 4S running the Instant Heart Rate application by Azumio to check the patient' …

  1. Anonymous Coward
    Anonymous Coward

    Interesting. A haematologist has never made any such prediction before taking my blood at the regular intervals. They ask me to clench my fist purely to make the vein visible while they push the needle in.The inability to find a vein easily is usually ascribed to my having not drank enough water when on the preparatory fast.

    1. scarshapedstar

      Explained

      Well, he doesn't need to, because he's not drawing from the artery at regular intervals, I hope. (Pardon me, but out of curiosity - hemochromatosis?)

      The point is that you have two arteries running to your hand, the radial and the ulnar. In healthy people one can take over for the other for a while if someone blocks it with strong pressure or an arterial line (used to measure blood pressure in critically ill patients on pressors, stroke patients with a very specific blood pressure goal, etc).

      In people with say vascular disease or variant anatomy, the hand needs both and will die otherwise. So you have to put your line elsewhere.

      It probably should be performed before arterial blood draws because it is possible, albeit rare, to really mangle an artery. But hardly anyone does this because usually the one drawing the blood is a panicked, sleep deprived physician in training who is under a lot of pressure to get that blood immediately.

      1. Anonymous Coward
        Anonymous Coward

        Re: Explained

        By "regular" I meant every six months. The tests are to monitor my Type 2 diabetes - and the potentially harmful side-effects of various drugs. I would assume the hardening would start to be relevant in in my dotage as the diabetes causes the blood vessels to be constricted prematurely.

    2. Pat Harkin

      That's because they're going venous, not arterial, access. It's hard to do significant damage entering a vein but if you damage the radial artery the viability of the patient's hand depends on collateral circulation from the ulnar artery and if that isn't good the result can be catastrophic.

  2. Crisp
    Coat

    No point having doctors struggling in vein.

    I'm going.

  3. Dodgy Geezer Silver badge

    We need an...

    ...upgrade for the Human Body to match our new smartphones....

  4. Alister

    wrong vessel

    The article (and some previous commentards) seem to make no distinction between arteries and veins.

    In all but a few extreme cases, it is normal to take blood from, or inject drugs into, a patient's veins, and NOT the arteries. The name sort of gives it away really, it's an Intravenous injection, or IV fluids that are given.

    Unless you are doing something clever like blood transfusion or dialysis, you would not deliberately stick a needle in an artery.

  5. Jemma

    Not in a month...

    Of Saturnian Sundays.

    You put an idiotphone near me in a hospital and you are very likely to spend the next 4 hours disentangling it from your lower orifices.

    I had a BCC (skin cancer) that was misdiagnosed for 9 MONTHS because of some cretins taking pictures with iPhones - it's spread down my arm and I've had to have two surgeries and on top of that pay for a correct diagnosis and had abuse off my former surgery for suggesting they might be wrong.

    On top of that I've been told by an experienced NHS GP that BCC doesn't spread when it's favourite sites to spread to are lungs and brain and wouldn't you know it my eye sight has just gone strange..and a lot more headaches than usual.

    If you think you might have cancer, go private. And if anyone waves an iPhone in your face the correct response is "do you want lube with that?"

    The thought of iPhones being used with possible stroke/TIA/heart attack or heart disease patients as a diagnostic tool makes my blood run cold.

    PS : the one time the NHS took blood from an artery they managed to cock it up so comprehensively that I bled into my wrist - had a catastrophic drop in blood pressure and woke up on oxygen. It took me longer to recover from that medical treatment than it did the last Western Hognose bite I got and that was so bad I could have used everything below the elbow as a lethal weapon as it was swollen practically solid...

    1. Notas Badoff

      Re: Not in a month...

      I believe you and you have my sympathy.

      Doctors, GPs, are not all as prepared as we'd like for life as actually lived by patients. You'd like to split the difference between a new one that knows everything but hasn't seen much, and an older one that has seen everything but unfortunately no longer knows everything current.

      When one hand and arm were going completely numb one afternoon, I took a shower and went to hospital. ER doctor takes a look, and says "well, we know you weren't bitten by a rattlesnake - no holes", but with no other helpful diagnosis. (Was actually an extreme reaction to stinging nettle I figured later, after repetition)

      Separately, it took 7.5 years for a simple metabolic problem to be diagnosed because it presented so similar to something else, and those tests were negative. Finally I showed up with a letter comparing in two columns two different disorders, showing how much they could resemble one another. "Oh, we have a test for that one!" Four days after receiving the ensuing Rx I'm the person I was eight years before.

      Investigate. Research. Be interested in your own health. You may be the only one who is.

      BTW: My appt with the dermatologist is on Thursday. Life's "go away!" stuff doesn't go away by itself.

      1. Anonymous Coward
        Anonymous Coward

        Re: Not in a month...

        My favourite "war story" is having witnessed how badly the NHS deal with something as simple as a dislocated shoulder (surely dislocated shoulders are what you learn in Doctor kindergarten ? )

        "Doctor" number 1 post so-called "examination" : "You'll be all right, go home, here have some strong painkillers".

        Patient expresses dissatisfaction with diagnosis. Requests second opinion.

        Enter stage left "Doctor" number 2, cue "examination" and mutterings with Doctor number 1.

        Doctor number 2, "well, you should be ok, but if you like, whilst you're here, you can have an X-ray, I don't think its necessary though".

        Patient expresses desire for X-Ray. Doctor scribbles on a piece of paper and sends the patient down the corridor to the X-Ray queue.

        Wait .... X-Ray .... Back to Waiting Room to wait ....

        A new face, Doctor number 3 appears to summon the patient.

        Doctor 3 ... "that looks painful and I've now seen the X-Ray too, its obviously a dislocation and we need to do something about it".

        TL;DR ....

        (1) It took the NHS five hours to correctly diagnose a simple medical issue

        (2) It should not take a total of 6 so-called doctors to resolve said medical issue (three "doctors" time was taken up in diagnosing the issue, and different three "doctors" time was taken up in resolving it - although the resolution process felt like an impromptu training session although they refused to admit it).

  6. Pascal Monett Silver badge
    Windows

    "our study highlights the potential for smartphone-based diagnostics"

    Congratulations on finding yet another excuse to shove those abominations into another aspect of our private lives, you pricks.

    Now, where's my industrial-strength can of RAID when I need it ?

    1. Throatwarbler Mangrove Silver badge
      FAIL

      Re: "our study highlights the potential for smartphone-based diagnostics"

      Yes, by all means, let us deny clinicians more effective tools because you don't like them.

      1. Jemma

        Re: "our study highlights the potential for smartphone-based diagnostics"

        They are NOT an effective tool if they result in an incorrect diagnosis and of all the smartphones on the planet the ones with the more dismal cameras are iPhones.

        If your going to use a smartphone camera for diagnostics you go buy a job lot of Nokia 808 Pureview, not cretinphones.

        One trained human looking at my arm diagnosed cancer in less than 3 minutes. After it took 12 *months* of verbally abusive NHS fucktards, 2 trips to the womble in centre and £150 to actually talk to someone who wasn't the NHS equivalent of a British Leyland quality control drone.

        And just to give you a warm feeling - the *third* tumour resulting from this situation is just showing its happy little face.

        SO I'VE GOT ANOTHER THREE MONTHS OF DEALING WITH SUB AVERAGE CRETINS WHO ARE MORE WORRIED ABOUT THEIR BUDGET THAN THEIR PATIENTS TO LOOK FORWARD TO.

        If I had seen a trained diagnostician instead of a trained monkey with an idiotphone I wouldn't be suing the NHS. I would have been given the right treatment, the NHS would have been able to do it in 2 weeks, not TWO FUCKING YEARS and everyone would be happy.

        So personally the next time someone waves an iPhone in my face and I'm still in control of my faculties it'll be rammed where the sun shineth not*, sideways for preference.

        *and I don't mean that small valley in the Ramtops.

  7. Jemma

    Mirtazipine

    PPS: if you have allergies and a doctor mentions the word Mirtazipine in your presence - the correct course of action is either hell no or, to quote Monkey Dust, I will beat you like a Chipperfield Monkey..

    Mirtazipine can cause a histamine storm - imagine you are allergic to everything up to and including the kitchen sink. I had that and managed to go to London on the worst pollution day of the year. Within 2 hours my face was so swollen I was practically blind. Within 4 hours I was coughing fit to bust a rib, in fact I fractured two.. Within 48 hours chest x rays because my lung function had dropped by 75%. It took me almost 18 months to mostly recover.

    But this is the dangerous part. It doesn't happen when you are on the medication - it happens after you've come off after about 2 weeks - since the medication isn't suppressing histamine production/receptors the whole system goes utterly nuts.

    Anyone with asthma it could easily kill them - my peak flow was 600+ before this happened - it went as low as 120-150 - and it's still not back up 4 years later!

    1. Anonymous Coward
      Anonymous Coward

      Re: Mirtazipine

      DISCLAIMER: I am not a doctor, or a pharmacist or any other person qualified to talk about POMs.

      Disclaimer out the way, I've looked up Mirtazipine on a medicines database and it seems the therapeutic indication for that drug is "treatment of episodes of major depression".

      It would seem to me that something went badly wrong in the prescription process if your hypersensitivity to the active substance or to any of the excipients was not given due consideration ?

      1. Jemma

        Re: Mirtazipine

        Yup you're right - only problem is, as I said, I'm not sensitive to the active itself - because I have an allergy to cats - I reacted to what happened when I came off it. The fact that my already slightly sensitive histamine system got a nice fat dose of air pollution when coming off mirtazipine had jacked its sensitivity up 500%... which of course my GP didn't bother to warn me about and most medical professionals haven't even heard about.

        If anyone has a nut allergy or something that needs those epipen shots the histamine storm caused by the reactivated histamine receptors going hyper could easily kill simply because you're not just allergic to your allergen at that point you are allergic to everything and even everyone around you. I've a cat allergy - I stroke a cat and rub my eyes I look like I've gone two rounds of boxing. Now imagine the state I'm in in an underground train and my immunity has gone hyper and I'm reacting to everyone who's been anywhere near a cat in the last 24 hours.

        There's cases of people with nut allergies where even the *smell* is enough to set them off..

        Best part? I wasn't even depressed.

        And FTR it could only be mirtazipine because that was the only medication I'd been on at the time and it'd been two weeks to the day from my last dose.

        sadly from my research I'm not the only one this has happened to.

        Now I'm going to sleep cos I've a car to go pick up in the morning and drive back. 1971 here I come.

  8. FozzyBear
    Flame

    It appears many doctors need as much help as possible nowadays, for even the most basic examinations. My dad fell 6 meters at a work site some years ago. Waking up in hospital, they did a some tests and x-rays. The attending doctor released my dad the same day saying , very lucky indeed just some bruising and other soft tissue damage.

    Ignoring the obvious concussion and complaint of severe headache, not to mention the 3 broken ribs and the hair line fracture to the right wrist. Lucky indeed.

    Anything that can compensate for that level of ignorance, incompetence or laziness is a good thing

  9. Geekpride

    Testing this out with a smartphone was probably a good way of testing the technology and technique in principal. To be used in clinical practice, it would probably make more sense to integrate it into existing equipment. As the test involves looking at colour changes in the index finger, it would make sense to add this test to the finger mounted blood oxygen meters that are widely used in hospitals.

    1. imanidiot Silver badge

      This. Good proof of concept, now it's time to implement it on stuff actually designed for medical use. If this works on the color change on a smartphone CCD it should work using one of those cheap disposable pulse-oximeter sensors already in use in hospitals..

      1. Jeffrey Nonken

        Exactly. You learn new things by trying new things, then do research and development to refine them and turn them into working equipment.

        Otherwise we'd still be using leeches.

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