Hand Tremors

Every paramedic at some point in their career will find themselves having to cannulate in a difficult (and nerve racking) situation, and they will pull out all their cannulation gear, only to find that their hands are shaking (hand tremors).

What causes this, and how can I still cannulate if this happens?

Unless you have some particular medical condition, such as Parkinson’s Disease hand tremors are fundamentally caused as a result of the brain suggesting (on no uncertain terms) to the adrenal glands to release more adrenaline as a result of some sympathetic stimulation (fight or flight response), and it is this circulating adrenaline that makes your hands shake or tremor. Now, everyone’s sympathetic nervous system responds differently to a situation. For some, even if they are nervous or agitated, they do not release much adrenaline, in others, they may be only mildy anxious, and their hands start trembling uncontrolably.

When I started as a paramedic (over 10 years ago now), I found my hands developed a small tremor just before I cannulated a patient, and progressively develloped into a severe, uncontrollable tremor by the time I had finished cannulating. Over the years, I had assumed that my hands would cease to tremble once I had become experienced and confident in cannulation and in my duties as a paramedic. This was not the case, and here I am, more than 10 years later, with terribly shaky/trembling hands everytime I go to cannulate (even when I really don’t feel nervous).

So what do you do?

I’ve successfully cannulated somewhere around the 8000 times mark, but still my hands shake… most new people who I work with assume I’m nervous or not good at my job. But I very rarely miss a cannulae, and everyone who has worked with me, will ask my help to cannulate if they are having trouble with a patient who has difficult veins.  So this is what I do. I’ve already been to the Doctors and rule out any organic cause for hand tremors (such as Parkinson’s Disease or Hyperthyroidsim).

When I go to cannulate, I get everything ready…  I pick my vein, clean it, and get it ready for venepuncture. Then I make myself comfortable. If I’m in the Ambulance, I sit down and make sure the arm is resting on the patient’s lap or my knee so that I have something to brace myself on. I normally calmly talk to the patient about, just about anything that he or she wants to talk about (their work, the weather, I don’t really care what, just so long as I’ve got them thinking about other things, and it gives them the idea that you know what your doing so well, that you can concentrate solely on them and still cannulate). If I’m at a patients house, I will take a chair that is nearby (if one exists) and use it to make myself comfortable (alternatively, I will crouch down or even sit down if it is safe to do so). Then, when I’m all ready… I firmly anchor the vein down with my left hand  (I’m right handed so I cannulate with my right hand). And I visualise exactly where the cannulae needs to go and then I insert the cannulae. The whole process of venepuncture (puncturing the vein as you insert the cannulae) generally only takes me about 5 seconds (but may be longer if it is a difficulate vein to cannulate. I find, if you’re going to successfully get a cannulae in, it will either take about 5 seconds or it wont happen at all. My hands are far too shaky to actually stay and fiddle with the fine motory skills required to cannulate. But so long as I anchor the vein well with my left hand, and rest my right on my knee or something, it generally works.

If you want to see normal methods for stopping hand tremors, you may want to check my other article Stop Hand Tremors.