A 14 Gauge Needle and Strong Arm

In Samuel Shem's satiric novel, House of God, there is a housestaff rule: "6. There is no body cavity that cannot be reached with a #14G needle and a good strong arm." Though quite blunt, this is not a completely ridiculous adage. Over the last two and a half years of training, I have become much more comfortable placing a needle into someone who needs it. During intern year, I'd done a number of paracenteses: the drainage of fluid from the abdomen. Patients with liver disease often accumulate a lot of fluid in the belly and occasionally, it should be checked for infection or drained for symptoms. I hadn't done a paracentesis for over a year, but when a patient came into the ICU with end stage cirrhosis and severe ascites, I felt comfortable doing the procedure. I begin to see things in the way I imagine surgeons see them. Using a few basic principles, it's not too hard to access a vessel or body cavity with a needle. The skills of using ultrasound, the Seldinger technique, careful intentional movements, and manual dexterity apply to central line placement, arterial line placement, epidurals, spinals, thoracenteses, paracenteses, and other procedures. With a 14 gauge needle and a strong arm, any body cavity can be reached.