Thursday, August 8, 2013

The Ultimate Cannulation and Venipuncture Guide

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Needles are a part of medicine. Unfortunately, despite having been discovered centuries ago, there is still no more elegant way of accessing your blood than stabbing a pointy thing through your skin. 

So I guess, as a future doctor, it becomes my duty to be the best I can be in this aspect. God knows it'll be a major part of my training and (at least) the first five years of my career. May as well be good at it... if not for the sake of the poor beings I'll be stabbing, for my own pride. After been cannulated at least a hundred times... you'd hope I'd have gotten at least decent in it...

This list below is a bunch of tips that I've picked up over my time in hospital as a patient from the best phlebotomists in the business - and the worst. It won't go through the absolute basics - I'm sure you can find those in medical text books or handouts and the like. Here's the absolute basics - with nice pictures too if you can't! In future posts - I'll go into things like subcutaneous injections and local anaesthesia as well - as I gain more experience with them.

You can help out by posting a comment about any awesome tips that can help that I may have missed - and by sharing it - with other medical students, doctors, nurses, blood collectors and even patients. Discuss it below, put in some of your best and worst experiences with canulations, sub-cuts and blood taking - and I'll definitely put any good tips I missed into the post. 

I've also got in touch with an old friend who's working in a path lab, and she's let me know of some further insights into how blood taking methodology can alter results, and, more importantly, how to reduce those alterations! Doctors take these results as gospel truth - but it's important to note - alterations can happen and results can and do vary depending on how it's collected. 

A health-sector filled with good injectors will mean a health-sector filled with happier patients - not to mention one more open to giving blood, joining the bone marrow donor registry and picking up diseases before they become serious! AND a population of patients with more accurate results! So it's in everyone's best interest to share their experiences and share it with their peers!

THE TIPS:


First off - ALWAYS check the necessity of using a needle in the first place. In many wards, patients commonly have central lines, Hickman lines and other such things which negate the necessity for cannulas and blood tests - and they're being used more and more. In my own case, nurses would always take bloods from my central line in the morning and I'd only need cannulas if I needed contrast for CTs, or some form of sedation (both of which can't be injected into a central line). Majority of my blood tests, aside from cultures, were done through the line as well.
Though central lines and other such non-invasive (well, at least not after they're put in) measures are being used more and more in hospitals, you will still have to resort to cannulation and venipuncture more often than not. And if you have the opportunity to have it done under ultrasound guidance - DO SO! 
But without further ado - here are my best tips:

Preparing yourself: 

 

1.       Make sure you have the correct basic equipment.  Often forgotten examples include:
        I.           -  An empty syringe - when taking blood it provides more suction than regular vacuum tubes so it can often draw blood where regular vacuum tubes can't. When cannulating, ask the patient (or check in their files) if any blood needs to be taken that day. It'll save them another jab which is always appreciated. The syringe should only be used though if the vacuum tubes can't. From the lab's perspective, too much suction causes haemolysis (destruction of red blood cells) which can alter results. If that syringe is needed, pull back slowly, allow the blood to pull itself back through the vacuum effect, to reduce the chances of spurious results.
      II.         -    A saline syringe to flush canulas. It should be already attached to the bung/cap of cannula. This saves on the pain of having to manually pull and twist the cannula an extra time when you first flush it (often, that's the bit that hurts the most). Nexiva canulas, which I'll talk about below, eliminates this need.
    III     -    A tourniquet to raise venous pressure and hence allow blood to flow. Failing that a blood pressure cuff works fine too and is actually superior as you can set the pressure to be above venous pressure (20 - 30mmHG) yet below arterial pressure too (100 - ish mmHG) to ensure blood pooling without undue risk of hypoxia/ischemia to the hand. 
                    Gauze or cotton balls. A must - I'd keep a few ready and one placed below, or a bluey (or some other, disposable sheet) if possible where you're about to inject. Blood inside cannula dressings can be an infection risk, and if you miss you should be ready to clamp down on it straight away. Bloody sheets/pillows are never fun.
      V.        More than one strip of alcohol wipes, in case you need more cleaning or if you're checking a few injection sites. It's not fun being left, anxious and alone in a room, waiting to get stabbed while a nurse or doctor runs outside looking for extra wipes.
    VI.        Gloves and other requirements for sterility. In many areas, cannulation is becoming a fully sterile procedure, and many wards/units are clamping down on "cutting the tip off the end of a glove" for infection reasons, so being able to cannulate with goves will become more and more important. Try and do them with gloves on.
  VII    Correct needles, of course. A butterfly is always best for the patient for blood taking purposes, when you only require small samples. Remember you will need to choose the best one for the job - depending on how much blood needed, how big or small the veins look, or, in cannulas, at what rate medication/fluids will be pushed through.
VIII    A small, yet short, plastic tube addition to the bung is also recommended. It will reduce pain for the patient from having to twist the cannula every time to flush it or when connecting new medications. Simply attach this to the end of the cannula and the nurses who administer medications through that cannula/port will no longer need to directly touch the injection site (reducing the need to move or twist it; thus reducing pain for the patient, as well as the infection risk). 
Rightmost tube is an example of what I'm talking about. Attach this to the bung and nurses and patients will find it easier and less painful to flush/access the cannula.

    IX      Tape to hold down any such additions as in (VIII) as well as to secure the IV tubes.
      
 THE NEXIVA CANNULA. 
           This new-ish type of cannula, pictured underneath, has a section of  tubing already attached so you will not have to come in contact with the blood at any point or touch the cannula once inserted.
                
                What makes it the best cannula to use is its basic function. The needle in this cannula is inserted the same way as a regular cannula - with your forefinger placed on the soft tab in the middle (the wings supported by middle finger and thumb). As you withdraw the needle itself though, you need not pinch the vein down proximal to injection site as blood enters the tube meaning you will not come into contact with the blood or have any blood spurting everywhere.
                  After you insert you see initial flashback, followed by a second flash which is where you stop threading it. 
The amazing thing about this is the needle itself. When you remove it, simple pull back on the tab at the end and it pulls out with a cap on the tip - so needle sticks are COMPLETELY eliminated making it MUCH SAFER for the injector. 



Nexiva cannula pictured above. See sources below for more info. Notice the needle itself can be pulled out with a cap on it (grey part).


2.       Make sure you gather all the correct equipment and keep it on a tray/trolley on your non-injecting hand's side. This will ensure that you can reach all equipment easily without it getting in your way.
3.       Try to be seated comfortably or, at worst, be kneeling, rather than bending over a patient. Unfortunately you may have to spend a while looking for a site to cannulate or injecting properly and hence a sitting down position with the patient high in the bed/seat (so you don't have to bend over) is best.

Preparing the Patient:


Often ignored, but vitally important is the patient's own preparation. But luckily there are ways you can help out, even if you just inform your patient so they know better for next time:
1.       Try and get the patient to be properly hydrated before cannulating/taking blood. The more fluid and blood in you, the more likely it is to pool up in your veins, where you're trying to go. Also, increasing turgor of the skin allows for easier injection.


My arms 20minutes before and after drinking two glasses of water (obviously not - but in reality it does make a huge difference - one reason why I think doing blood rounds in wards just after patients wake up isn't too smart even though it's easier for doctor's rounds.)
2.       Ask the patient if they've got any preferences based on previous experiences - especially if they have been cannulated often. I guess that some patients who have only had a few may not be experts on the matter, but at the same time I feel doctors in particular who cannulate me will often go for veins that I have insisted simply do not work (some god complex - "what would you know, you're just a patient" mentality) and, more often than not, they'll fail. I MEAN C'MON! I've had at least one hundred by now - and many patients are in the same boat, so if they have had a few before and it isn't contraindicated - do listen to them. 

3.       In order to make palpating the veins easy - place a heat pack over the arm/area which is most promising. It causes vasodilatation as blood attempts to cool itself by pooling to the surface in your veins and hence makes palpating and cannulating easier.
If a heat pack isn't available, fill a glove with hot water and place it on desired spot or run a towel under hot water. I picked up this little trick once in the ward where they didn't have a heat pack so there will always be a way to do this =]




4.       Talking to the patient is VERY effective in reassuring patients and will reduce occurrences of syncope and also reduce vasoconstriction due to anxiety and the fight-or-flight response. Anxiety will also mean faster blood return to the heart, meaning less blood in veins to draw blood/cannulate easily. A two way dialogue will be best for this. Seeming confident will also reduce a patient's anxiety, and hence make you more likely to get it right the first time. So even if you're not that confident, act like you are - putting on a false bravado about your skills will not only help your patient, but also you as you won't hesitate and miss by accident.
5.       If veins seem hard to spot or palpate, place the arm you wish to cannulate below heart level with a tourniquet on it before resting it up in a position to inject. This will increase blood pooling to the veins due to gravity and the tourniquet will further the pooling effect.


6.       Don't forget to ask if they have any conditions which will make this hard/messy - eg) blood thinners, low platelets etc. and plan for it by having the appropriate gear with you.
7.        Although smaller needles are nicer for the patient - they can alter blood results (very fast flow through the needle can cause haemolysis too!) slightly, and slow down the drawing of blood, making it more likely veins can collapse. Too large though, and it'll not only be more painful, but also more easy to miss. Getting the right balance is key!

Choosing/readying your site:

 

1.       TAKE YOUR TIME AND DON'T BE AFRAID TO PASS IT ON TO SOMEONE MORE EXPERIENCED IF YOU'RE NOT CONFIDENT. Too often I've seen doctors/nurses rush in to cannulate and miss and end up spending twice as long looking for another vein (often only to miss again)!
2.       When looking for veins, always try and rely on your sense of touch first. Seeing veins is always a good hint of where to go, but a vein should feel soft and spring back - even more so when the tourniquet is placed above it and other preparation measures are applied - and often sight can be deceptive as less suitable, superficial veins will seem more appealing.
3.       For regular venipuncture, the cubital fossa is often a good place to look first. Care must be taken not to inject the brachial artery, but the veins are often large and always closer to the surface. However, for cannulation, the forearm, the dorsum of the hand and a vein on the radial border of the distal part of the forearm are more promising (although the wrist veins are usually small, painful and restrict movement).
The cubital fossa is more susceptible to kinks 
and having the cannula tissue/extravasate, as patients move around at the elbow a lot, . People underestimate the pointiness of the actual plastic cannula and don't realise that it can penetrate the vein from inside if it moves around too much! Unfortunately, in emergency wards, they often attack this vein unnecessarily for cannulation because it's easier to get. In my eyes - it shouldn't happen if a patient is being sent up to a ward or observed - only reserved for "get the cannula in or die" situations.
4.       There are deceptive muscles and tendons in your hands that will feel like veins. So get the patient to flex a few times if you're trying to differentiate between a vein and muscle.
5.       Forked veins seem to roll less but remember - they often have valves by the bifurctication. So instead of going in at the bifurctication, go slightly proximal to it (in order to avoid valve yet still get a vein that is less likely to roll)
6.       Place the tourniquet about 20cm proximal to a promising site. Too far will not ensure enough pooling and too close may just constrict your entry point. It is generally considered safe to have a tourniquet on for five minutes maximum before ischemia becomes an issue - though I wouldn't risk getting too close to that time, and wouldn't tighten it too much.
7.       Look for already straight veins. Pulling the vein straight won't do anything when choosing a sight or when injecting, as it will revert to its original position.
8.       Valves can be tricky. However, they are palpate-able as small dips as you pass along a vein. Avoid these at all costs as they are very hard to navigate out of and cannulate/venipuncture. 
Remember valves are there to stop blood flowing away from the heart in veins. Therefore - if you palpate one on a promising vein, inject to the proximal side of it so you aren't stuck behind the structure.


9.       Tap the vein gently in order to vasodilate the veins. Doing so will cause slight stress in the vein to release NO which is a vasodilator as well as histamine from mast cells which have the same effect. Rubbing gently has a similar effect and is actually more effective on cubital fossa veins.
10.   When sterilising the skin with alco-wipes, allow at least 30 seconds for it to air dry. Not only will it allow more bacteria to be properly dealt with, it'll mean the stuff won't sting if it gets pushed into the vein. Fanning or blowing it will only increase chances of infection and cause the alcohol pool up in areas, potentially increasing the stinging as you inject.
11.   Place the patient's hand on a pillow or a stable yet soft object in a comfortable position as you are about to inject both for comfort and ease of access for you. Don't forget to have a bluey or piece of gauze underneath where you're entering for cannulas!

Going In - keeping the patient calm and getting it right:

 

You've picked your spot and have it fully prepared. Now all you've gotta do is get in there.
1.       To stop vein from rolling away, pull the skin and muscles a few centimetres from the vein taut. Do not attempt to straighten the vein overtly, as, as I've mentioned before, it will retract to its usual state as you inject anyway, causing tissuing and more pain.
2.       Distraction therapy is helpful. Not only can you talk to a patient as it is about to go, I'd suggest getting them to look away. The natural fight-or-flight response will quicken heart rate, even subconsciously, and cause less blood to pool in the veins you're aiming for. Other methods include getting them to focus on doing other things like wiggling their toes or tapping on a table (not your rest table of course) to get their mind off it.
With kids in particular, this is vitally important. You cannot lie to them about the pain, as it may lead to involuntary jerks or movement as you inject, but getting their mind off it will definitely help. Again, the trusty glove can be blown up and have a smiley face drawn on it to make it look like a spiky-haired friend. Definitely will cheer up the kids =]


3.       Hold the patient's arm firmly with your non-injecting hand, as involuntary jerks are common and can disrupt the procedure. Also be sure to watch for any signs of syncope.
4.       As you inject, the best angle, in my experience (and that of the best jabbers I've talked to) is anywhere between 10 and 30 degrees. Also, a quick jab as you pass through the skin is most effective in reducing pain - although taking it slow after you hit the vein wall is essential. You don't want to jab through the other side.
5.       Don't forget to point the bevel up towards you!
6.       Local lidocaine, a weak anaesthetic, is also an effective way to stop pain. But only if you can master injecting it into the dermis (level of skin just under the surface) rather than into the vein. A small jab into the dermis only 1 or 2mm into the skin followed by a slight push of only one or two drops should be enough to make the cannulation almost painless. This is usually more useful in larger gauge cannulas or on difficult-to-cannulate patients, and, like any local, you should give it time to take effect before penetrating the skin again for the cannulation.
7.       Don't feel you have to inject from right above the vein! Pressure directly on top of the vein can often cause elastic veins to roll more, so going at an angle and entering the vein under the skin rather than going straight above it can help. 

8.       Once you are inside, and you see a flash of blood, go a few millimetres deeper in order to ensure that the cannula is genuinely inside the lumen of the vein and not just the needle tip. Has happened to me a few times where they removed the needle too soon and just ended up being a bloodier-than-usual miss. 


As you can see in the picture above, the cannula may give a false impression of being inside the lumen when only the needle point/bevel end is. Going only a little deeper will ensure the cannula is properly inside. Using a nexiva cannula while withdrawing (requires a bit of practice) the needle removes this necessity. 

9.       If you do not see the flash of blood, do not immediately remove the needle. Attempt, with consideration for the patient (as it can be painful) to withdraw the needle a few millimetres in case you went to deep. The needle may be resting on the opposite vein wall, so doing this will ensure quicker blood flow into the needle during venipuncture in particular.  
Palpate around the needle to see where the vein is and where you should go if you need to adjust it further. Though painful, in my experience, and from what nurses and doctors have told me, "digging around" for the vein after you've missed is less torturous than having the needle reinserted elsewhere.
10.   If you do happen to miss, you should have a piece of gauze/a bluey underneath your spot so blood spurting should be fine. Remove the needle and cannula as usual and immediately press down to prevent bruising from blood seeping into tissue.
11.   If you have missed, try the other hand, or choose a spot that is proximal to the elbow on the arm as it will not be impacted by the miss further down on the vein as severely.
12.   When taking blood, remember to keep the vacuum tube ready to insert into the suction cap. If that doesn't work use the empty syringe instead to pull out blood. As it has a more powerful vacuum, it can often produce results where the vacuum tube cannot - though care should be taken to make sure you don't end up pumping air into the vein. Remember, you should always try to take blood from a cannula if it's required as patients like me will definitely appreciate not having to get stabbed twice. Do not do it after flushing cannula though as it will heamodilute the blood sample thus distorting results. 
13. TAKE THE TORNIQUET OFF AS SOON AS BLOOD IS BEING DRAWN! It's OK to leave it on prior to a patients' blood being taken, but too long can alter results slightly. Ideally, it should be removed/loosened as soon as blood starts being drawn. 
13.   Flush after placing cap on needle. As you are placing the cap, pinch the vein a few centimetres proximal to injection site to stop blood from spurting out.

POST CANNULATION

 

1.       Try and put a small tube that extends beyond the cap of the cannula and tape it down along the length of the forearm/arm. This ensures that the patient will not have to have the cannula twisted every time it is accessed and hence reduces chance of kinking and extravascation inside the vein too. 
 As seen above - there is a small tube attached to the cannula which the nurse is flushing the cannula with. This avoids having to twist and move the actual cannula when using the cannula. 

2.        When required, or if delays are occurring during blood collection for whatever reason, keep already collected tubes moving (turn them from facing up to down rapidly 5 times) to reduce the chances of the blood clotting too early and distorting coagulation results.
3.       Anchoring the cannula. The most powerful anchor on a cannula I've seen and had done on me was to place a strip of tape underneath the cannula, perpendicular to the direction of the cannula with the stick side facing up. Criss-cross the tape around the insertion site, making a "bow" shape (see picture below). Place your usual, preferably transparent dressing over the cannula as you usually do and finish by placing a strip of tape again perpendicular to the cannula direction, but this time toward the cap to anchor it firmly. Although you may not see the injection site, most problems arise from the cannula slipping out rather than an infection near the entry site (which can be seen through this anchor anyway) so a good anchor like this IS necessary. 
 That's right... admire my impressive paint skills.

4.       Give the patient a "sock" to place over the cannula. Can be easily created from a cotton ribbed stockinette (easily findable in any medical store-room) by cutting a decent length of it out, enough to cover cannula and portion of forearm, and making a small slit on the side where you can feed the patients thumb through. This will protect the cannulation site and stop unnecessary kinking and pain on the patient's end too. 

Removing the needle:

 

1.       Again, keep a piece of gauze ready as you remove the cannula/butterfly/syringe.
2.       Immediately after removing it, press down hard on the insertion site. This will reduce bruising significantly post removal as the major cause for bruising in this procedure is allowing blood to seep into the tissue and hence bruise the area. Ask the patient to hold it down for two minutes after removal of cannula. 
3.       A very good tip is to tie a tourniquet around the insertion site very tightly (around a piece of gauze/the dressing of course). This causes any bleeding to stop rapidly and will significantly reduce bruising and bleeding.



So these are the best tips I've picked up over years of being cannulated by the pros! 
Remember - share this with other patients, med/nursing students and doctors and anyone else who may be interested and share your experiences/own tips by commenting below! If I see really good ones - I'll definitely add them to the post. It's all about improving the experience for the patient so don't be ashamed or shy to do so =]

https://www.facebook.com/musingsofamedstudentpatient <-- If you or a loved one needs help or if you enjoy my blogs or if you're interested in medicine, like my page on facebook =]

Nexiva cannula - more info/reference and details on if they're in your hospital:
http://www.sarb.be/fr/journal/artikels_acta_2005/artikels_acta_56_3/acta_56_3_vanzundert.pdf


 

72 comments:

  1. Hey guys - be sure to comment your own experiences and tips for cannulating too! Discussion on this topic would be great as I've had both really good and bad injectors work on me so it'd be good if we could shift them all towards the "good" side =P

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      Delete
    10. Having Herpes is a Terrible Experience and my Experience will help some hsv patients beware of Herbs from online doc.
      I was positive to the deadly virus called HERPES and i lost hope because i
      was out casted and rejected even by my closet friends.
      i searched on-line to know and enquirer about cure for HERPES and i read
      someone testimony on how he was cured from HSV-2 so i decided to contact
      the same herbalist Call Dr Edidia because i know that nature has the power
      to heal everything.
      i contacted him to know how he can help me and he told me never to worry
      that he will help me with the natural herbs from God!
      after 2 days of contacting him, he told me that the cure has been ready and
      he sent it to me via UPS SPEED POST and it got to me after 3 days!
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      Delete
    11. Having Herpes is a Terrible Experience and my Experience will help some hsv patients beware of Herbs from online doc.
      I was positive to the deadly virus called HERPES and i lost hope because i
      was out casted and rejected even by my closet friends.
      i searched on-line to know and enquirer about cure for HERPES and i read
      someone testimony on how he was cured from HSV-2 so i decided to contact
      the same herbalist Call Dr Edidia because i know that nature has the power
      to heal everything.
      i contacted him to know how he can help me and he told me never to worry
      that he will help me with the natural herbs from God!
      after 2 days of contacting him, he told me that the cure has been ready and
      he sent it to me via UPS SPEED POST and it got to me after 3 days!
      i used the medicine as he instructed me (MORNING and EVENING) and i was
      cured!
      its really like a dream but i am so happy!
      thats the reason i decided to also add more comment of Him so that more can
      be saved just like me!
      and if you need his help, you can email him on dredidiaherbalhome@gmail.com
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      here is the Dr website https://dr-edidia-herbal-home.business.site/
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      Delete
    12. HPV cure with the help of a herbal medication by Dr Ben for help contact now to get your own cure

      I think this site is useful in all that is suffering from HPV can show it to their friends and family and then there is a greater understanding I don't just know the reason why some people are finding it difficult to believe that, there is a cure for HPV, I have been suffering from HPV since 9month now but today I am happy that i am cure from it with the herbal medicine of Dr.Ben the great healer sent to me,I was browsing the internet searching for help when I came across a testimony shared by someone on how Dr.Ben cure his HPV I was so much in need of getting his treatment so I contacted Dr.Ben for the HPV cure.I am so much happy today that we have someone like this great herbal Dr Ben who has the cure to all types of virus contact Dr Ben on email address:


      Benherbalcure@gmail.com
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      Website http://benherbalcure.webs.com/

      Delete
    13. Having Herpes is a Terrible Experience and my Experience will help some hsv patients beware of Herbs from online doc.
      I was positive to the deadly virus called HERPES and i lost hope because i
      was out casted and rejected even by my closet friends.
      i searched on-line to know and enquirer about cure for HERPES and i read
      someone testimony on how he was cured from HSV-2 so i decided to contact
      the same herbalist Call Dr Edidia because i know that nature has the power
      to heal everything.
      i contacted him to know how he can help me and he told me never to worry
      that he will help me with the natural herbs from God!
      after 2 days of contacting him, he told me that the cure has been ready and
      he sent it to me via UPS SPEED POST and it got to me after 3 days!
      i used the medicine as he instructed me (MORNING and EVENING) and i was
      cured!
      its really like a dream but i am so happy!
      thats the reason i decided to also add more comment of Him so that more can
      be saved just like me!
      and if you need his help, you can email him on dredidiaherbalhome@gmail.com
      or whatsapp +2349074505296
      here is the Dr website https://dr-edidia-herbal-home.business.site/
      and also his facebook page
      https://www.facebook.com/dredidiaherbalhome/

      I,m rosesharon and you can get intouch with me via rosesharon915@gmail.com

      Delete
  2. I've always hated needles but these tips are interesting. Hopefully i won't need to many though soon though but I like the bit on how the patient can prepare himself too. And you wish that was your arm after drinking water haha!

    ReplyDelete
    Replies
    1. I love your blog often look to you. Article is good.
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      Delete
  3. On preparing to the patient:
    -ask them if they've had their blood taken before, if this is appropriate, or how they feel about it, if it obviously happens a lot. This can be handy, because there are people who really haven't had blood taken, or who - if you ask - might tell you useful stuff .

    On sticking needles in children(if "don't" isn't an option):
    (some of which might be handy for other patients, especially if they have lousy veins, or are anxious, or confused).

    - I understand that no one wants to stick a needle into a child, and it's usually done only when it's needed, by someone who has had some experience doing it (although I guess those people all had a first time, and if it's your first time, align as many stars as you can, and if you can't, SERIOUSLY consider referring to someone else.

    - In general practice: if you rarely order bloods for children, it's sometimes better to inconvenience the patient by sending them to a large collection center.

    - I think "mojo" is a thing. If you do not want to put a needle in this person and aren't feeling confident, you're massively increasing the chances of missing. If the patient is pretty anxious about having their blood taken, and the person with the patient is also anxious, you need someone calm in the room. If that person isn't you, get someone else in there, and to persuade yourself that you can do it, before you try.

    - Emla is a godsend, use it if you have it.

    - Be honestly non-committal about the level of pain involved. Children are afraid of hurt, and this might hurt. Probably not much. Best advice I've heard for a youngish child "it will hurt a little, not for long. Can you think of some bad words you're not normally allowed to say? Ok, well, just this time, you're allowed to say all those words if it hurts"

    - Emla or not, children generally need to be restrained. This will require 1-2 adults. Kids reflexes are still on their side, and even older and compliant children will jerk away reflexively. If you don't know how to restrain a child (and it does vary by age), get someone else. If you aren't persuaded that their parents can restrain them exactly like you said, get someone else.

    (I feel like that is all obvious, but then I've seen it go well, and I've seen it go so, so wrong, also)

    Awesome blog.

    ReplyDelete
    Replies
    1. Great tips Claire - Yes that is something I will definitely add in actually - the whole "if you're confident, the patient will be confident" sorta thing is sooooo true. I am going to be writing a full post about it later on giving tips but it's something that SHOULD be in here too. Great tips with the emla (reduces pain for those wondering) by the way - thanks for the great comment - that's what it's all about - sharing so everyone benefits =]

      Delete
  4. We have manufacture I.V cannula.It’s painless, hypo-allergic, easy to use and breathable.It is convenient, durable and gives acomfortable experience to the user.

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  5. excellent, very informative and great tips

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  6. Amazing blog you post. there are so many tips given bt this post.Great job post some more related post.

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  7. Thank you very much for the guide on ultimate cannulation and venipuncture. http://livecustomwriting.com/blog/tips-for-students-how-to-beat-stress is a very good article. It is unlikely for a person to know many ways how to beat stress.

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  8. I've just come across this blog and so glad I have! I've just started a job as a practice nurse and have recently started doing phlebotomy. I can have days when I consistently get blood and then have a day like today where I miss a few and it really knocks my confidence! As for children... I dare not even think about that yet!! 'Tomorrow is a new day' is my constant mantra at the moment!!

    ReplyDelete
  9. This comment has been removed by a blog administrator.

    ReplyDelete
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    ReplyDelete
  17. I can’t believe this. A great testimony that i must share to all HERPES SIMPLEX VIRUS patient in the world i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites of how dr Ero prepare herbal medicine that cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the pills the doctor gave to me. Right now i can tell you that few months now i have not had any pain,delay in treatment leads to death. Here is his email:(dreroherbaltreatment@gmail.com) whatsapp him with +2348073673757 or text/call me (270) 693-5854....

    ReplyDelete
  18. Africa continent though we have heard a lot about them even when they

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    ReplyDelete
  19. I Was Diagnosed With Herpes 8 Year Ago I lived In Pain, With The Knowledge That I Wasn't Going To Ever Be Well Again I Contacted So Many Herbal Doctors And Also Visited Hospitals All In Vain My Condition Never Got Better I Was Determined To Get Cured, So One Day As I Was Browsing True The Internet I Saw A Past About This Particular Woman (Wilshere Stancy) Posted On How Dr Iyoha Saved Her From The Virus With Herbal Medicine I Decided To Contact Dr Iyoha On His Email Address: driyohasolutiontemple@gmail.com We Spoke On The Issue I Told Him All That I Went Through And He Told Me Not To Worry That Everything Will Be Fine Again So He Prepared The Medicine And Sent It To Me And Told Me On How To Use It,After 2 Weeks Of Usage I Went To See Doctor For Test ,Then The Result Was Negative,Am The Happiest Woman On Earth Today..Thanks To Dr Iyoha God Bless You, You Can Also Reach Him With This Details;

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    ReplyDelete
  20. I can’t believe this. A great testimony that i must share to all HERPES patient in the world i never believed that their could be any complete cure for HERPES or any cure for HERPES,i saw people’s testimony on blog sites of how DR IBHAZE prepare herbal cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my body stop gradually and i had to leave without the HERPES DRUGS the doctor gave to me. Right now i can tell you that few months now i have not had any pain,delay in treatment leads to death. Here is his email: dribhazeherbalhealingcentre@gmail.com his on WHATSAPP number is +2348136354191 and also you can also view his website dribhazeherbalhealingcentre.webs.com he also special on cureing 1. HIV/AIDS 2. HERPES 3. CANCER 4. ALS 5. HEPATITIS B 6. DIABETES 7. HUMAN PAPILOMA VIRUS DISEASE(HPV) 8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or Lupus Erythematosus) and FLU ...

    ReplyDelete
  21. 5 years ago I had warts, I was treated with some liquid applied to the warts they continued to grow and spread... The next 2 doctors did laser surgery to remove them. 1 year after the surgery, they grew back close to where the 1st ones were' so I was finally told it was hpv. I have had it for very long time, I contract it from my cheated boyfriend and I found out he was also infected and I end up the relationship between us. the warts was so embarrasses because it started spreading all over I have be dealing with this things for very long time the last treatment I take was About 2 years ago I applied natural treatment from Dr onokun herbal cure, a week after applying the treatment all the warts was gone. it's now 2 years and some months I don't have single wart or any symptoms of hpv. wow"" it's great, Dr onokun has finally cured me. Anyone living with hpv contact Dr onokun for natural treatment.
    His email address: dronokunherbalcure@gmail.com‎ or whatsapp him +2349064844957

    ReplyDelete
  22. God bless Dr. Lucky for his marvelous work in my
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    searched about some possible cure for HERPES i
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    was cured from HERPES, Dr Lucky truly you are
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    contact him through. EMAIL= (drluchyherbalcure@gmail.com ) or WhatsApp him +2348154637647 I Love you So much Dr Lucky God
    continue to bless you forever But remember beware
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    ReplyDelete
  23. God bless Dr. Lucky for his marvelous work in my
    life, I was diagnosed of HERPES since 2013 and I
    was taking my medications, I wasn't satisfied i
    needed to get the HERPES out of my system, I
    searched about some possible cure for HERPES i
    saw a comment about Dr. Lucky , how he cured
    HERPES,DIABETES,HIV,EX_LOVER BACK and
    CANCER with his Lucky medicine, I contacted him
    and he guided me. I asked for solutions, he started
    the remedy for my health, he sent me the medicine
    through DHL COURIER SPEED POST. I took the
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    was cured from HERPES, Dr Lucky truly you are
    great, do you need his help also? Why don’t you
    contact him through. EMAIL= (drluchyherbalcure@gmail.com ) or WhatsApp him +2348154637647 I Love you So much Dr Lucky God
    continue to bless you forever But remember beware
    of scams Good luck

    ReplyDelete
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  25. When life give you reasons to be sad say no. Make the world know that you have more than a thousand one reasons to smile. I almost gave up on my quest of finding a permanent cure to this nasty virus called HIV. I never thought i would be HIV negative again after been diagnosed in 2013, i have tried everything possible in life from one doctor to another, one hospital to another, series of tests, different kinds of medication, i had already lost hope until i melt silver sandy Philippe who kindly told me about DR.ODUDU who do cure difference virus by the preparation of herbs and roots. i searched about the DR online which leads me to a difference testimonies on about the great herbal DR. I so decided to made up my mind to give him a try, i contacted his email that was given in the post and I followed him with all amount of seriousness and i did all he instructed me. To my greatest surprise, the disease that seem incurable disappear within 20 days of using his remedy. I am writing this here in order to put you in the know that there is a cure for this virus. it time to stop believing in the medical doctors who do says to us there is known cure for Cancer Hiv and many more virus. i just want you known that if you are going through any health challenge, contact this man and follow his instruction diligently and have a disease free life. his email is (dr.oduduherbalhome@gmail.com) a living dog is far better than a dead lion and a good health worth more than wealth famous, so please get back your health by getting in touch with DR.ODUDU kindly get him contacted calling phone contact and his Whats App contact is +2348101571054 thanks. https://web.facebook.com/DR.ODUDUHERBALHOME/?fref=ts

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  26. When life give you reasons to be sad say no. Make the world know that you have more than a thousand one reasons to smile. I almost gave up on my quest of finding a permanent cure to this nasty virus called HIV. I never thought i would be HIV negative again after been diagnosed in 2013, i have tried everything possible in life from one doctor to another, one hospital to another, series of tests, different kinds of medication, i had already lost hope until i melt silver sandy Philippe who kindly told me about DR.ODUDU who do cure difference virus by the preparation of herbs and roots. i searched about the DR online which leads me to a difference testimonies on about the great herbal DR. I so decided to made up my mind to give him a try, i contacted his email that was given in the post and I followed him with all amount of seriousness and i did all he instructed me. To my greatest surprise, the disease that seem incurable disappear within 20 days of using his remedy. I am writing this here in order to put you in the know that there is a cure for this virus. it time to stop believing in the medical doctors who do says to us there is known cure for Cancer Hiv and many more virus. i just want you known that if you are going through any health challenge, contact this man and follow his instruction diligently and have a disease free life. his email is (dr.oduduherbalhome@gmail.com) a living dog is far better than a dead lion and a good health worth more than wealth famous, so please get back your health by getting in touch with DR.ODUDU kindly get him contacted calling phone contact and his Whats App contact is +2348101571054 thanks. https://web.facebook.com/DR.ODUDUHERBALHOME/?fref=ts

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  28. Thank you for shairing this informative blog for Iv cannula

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  29. When you initially use the nexiva for cannulation, is it okay to put a bung on before insertion, and then draw blood through the cannula? I have been told it is not ok by other nurses, but if we need to draw further blood later, we do it through the bung because it is attached to the nexiva.... I don't see what the difference is.

    ReplyDelete
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  31. This comment has been removed by the author.

    ReplyDelete
  32. Hello everyone, I was infected with the herpes virus and I got cured from the herpes virus few months ago after i contacted Dr Azuka. I saw a post on the internet after i have seek healing for several years from different doctors in California. I sent the Doctor a request for help, just a few email i followed his instruction and he sent me the medication. Now i am negative and i referred him to all my friend who had this same sickness and they have gotten their cure too. You can contact him via his email: Dr.azukasolutionhome@gmail.com or Phone call or whatsAPP: +2348132777335. While i was on his medication i understood that he can also cure HERPES, HIV/AIDS, CANCER, Male/female menopause, Miscarriage, Menstruation problems, PREGNANCY PROBLEM, EPILEPSY, GONORRHEA, LASSA FEVER, OBESITY, KIDNEY FAILURE, HYPERTENSION, FIBROID TUMOR, BRAIN FOG, EPSTEIN-BARR VIRUS and many more.

    Contact him today and get your problem solved.

    ReplyDelete
  33. ..I never believed in Love Spells or Magics until I met this special spell caster when i contact this man called DR. OBOITE Execute some business..He is really powerful..My wife divorce me with no reason for almost 3 years and i tried all i could to have her back cos i really love her so much but all my effort did not work out.. we met at our early age at the college and we both have feelings for each other and we got married happily for 5 years with no kid and she woke up one morning and she told me she’s going on a divorce..i thought it was a joke and when she came back from work she tender to me a divorce letter and she packed all her loads from my house..i ran mad and i tried all i could to have her back but all did not work out..i was lonely for almost 5 years…So when i told the spell caster what happened he said he will help me and he asked for her full name and her picture..i gave him that..At first i was skeptical but i gave it a try cos i have tried so many spell casters and there is no solution…so when he finished with the readings,he got back to me that she’s with a man and that man is the reason why she left me…The spell caster said he will help me with a spell that will surely bring her back.but i never believe all this…he told me i will see a positive result within 3 days..3 days later,she called me herself and came to me apologizing and she told me she will come back to me..I cant believe this,it was like a dream cos i never believe this will work out after trying many spell casters and there is no solution..The spell caster is so powerful and after that he helped me with a pregnancy spell and my wife got pregnant a month later..we are now happy been together again and with lovely kid..This spell caster has really changed my life and i will forever thankful to him..he has helped many friends too with similar problem too and they are happy and thankful to him..This man is indeed the most powerful spell caster have ever experienced in life..Am Posting this to the Forum in case there is anyone who has similar problem and still looking for a way out..you can reach him here:droboitespellcaster@gmail.com... CONTACT THIS GREAT AND POWERFUL SPELL CASTER CALLED DR. ZUBA ... HIS EMAIL ADDRESS IS droboitespellcaster@gmail.com... CONTACT HIM ON WHATSAPP ;+2348167554235 NOW AND BE FAST ABOUT IT SO HE CAN ALSO ATTEND TO YOU BECAUSE THE EARLIER YOU CONTACT HIM NOW THE BETTER FOR YOU TO GET QUICK SOLUTION TO ALL YOUR PROBLEMS..........

    ReplyDelete
  34. Herbal Medicine Cure Herpes Virus Contact Dr Zuku To Help You.

    my people Join me as i share the wonderful work of Dr.Zuku how he cured my Herpes 2 Disease, that almost took my life, i have lived with this disease and did all i could be cured but no way.i have been searching out on a cure to terminate my Herpes and on my search i found Dr.Zuku help on the lives of many people . and after i wrote to him on how to get a cure, he directed me on the steps and he prepared my herbal medicine and after he sent it to me True DHL to deliver the herbal medicine to me..within 2 week after using it that after using it, i will be cured, and that was how he sent me my medicine and after using it for 2 week i was found negative by my test result. why not contact him today on his email: drzukuspelltemple@gmail.com and he can still cured..HSV 2,HEPATITIS B,HIV/AID,CANCER,DIABETICS, his email via Blogs https://drzukuspelltemple.blogspot.co.ke/ also text/call: +16177296273 or web/site https://drzukuspelltemplewhereallkindsofproblemisbesolve.wordpress.com/contact/

    ReplyDelete
  35. nice post please keep sharing this kind of post . i read daily your blog
    http://www.ivcannula.com/cannula-with-wings-with-port.html

    ReplyDelete
  36. God bless Dr. ozman for his marvelous work in my life, I was diagnosed of HIV since 2010 and I was taking my medications, I wasn’t satisfied i needed to get the HIV. out of my system, I searched about some possible cure for HIV i saw a comment about Dr. ozman, how he cured HIV with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine through UPS SPEED POST. I took the medicine as prescribed by him and 8 days later i was cured from HIV,thank you dr.ozmanspellhome@gmail.com Dr ozman ONCE AGAIN THANK YOU SIR contact him whatsapp number +2349061515609
    1 cancer cure
    2 HPV cure
    3 ringing ear
    4 herpes cure
    5 fabriod
    6 HPV cure
    7 diabetes cure
    8 Get your ex back
    9 Hepatitis B
    10 Pregnancy herbal medicine

    ReplyDelete
  37. I am Raven Gallery From USA.. Never Believe what the medical doc say that there is a cure for HIV AIDS but i found that there is herbal cure for you HIV AIDS disease with a 100% guaranteed I am a prove of it, I and my Boyfriend was effected and no one know who got effected first, in 6months time, the symptom was very rapid, I was annoyed with the words coming out from my doc after hearing from there was no cure for my disease..few days later i meet a friend online we got to meet and he didn't live very far, and she directed me to this Great Magical herbal doc Akuna and i contacted, to cut my story short, in 2weeks after using his medicine, i and my boyfriend was diagnose negative. I never believe there was a Man out in the world to cure my Virus. Thank very much sir. i Admonish that you contact doc Akuna fast as possible to get cured like me. Email:drakunasolutiontemple@gmail.com or What App/Call: +2348154625070.

    ReplyDelete
  38. great blog its very easy to understand and I read daily your blog please keep it up .if anybody interested in iv cannula please click on this link http://www.ivcannula.com/cannula-with-wings-with-port.html

    ReplyDelete
  39. HOW I WAS CURE FROM HERPES WITHIN 7DAYS WITH THE HELP OF DR ehinomen
    HERBAL MEDICINE CONTACT DR ehinomen VIA drehinomenherbalhome@gmail.com

    You can also whatsApp dr ehinomen +2349073923283

    I am so happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS . I was positive to the deadly Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about Dr ehinomen online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drehinomenherbalhome@gmail.com) You can contact him today VIA drehinomenherbalhome@gmail.com He also have the herb to cure difference cure for any sickness

    (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA...

    kindly email DR ehinomen for your own cure if you have any disease listed above via drehinomenherbalhome@gmail.com

    ReplyDelete
  40. Save Your Relationship and Get Your Ex Boyfriend/Girlfriend Back!contact: covenantsolutiontemple@gmail.com is certainly the best spell caster online and his result is 100% guarantee.
    My Name jenny cloud form California,USA. After 12years of marriage, my husband and i has been into one quarrel or the other until he finally left me and moved to Texas to be with another woman. I felt my life was over and my kids thought they would never see their father again. i tried to be strong just for the kids but i could not control the pains that torments my heart, my heart was filled with sorrows and pains because i was really in love with my husband. Every day and night i think of him and always wish he would come back to me, I was really upset and i needed help, so i searched for help online and I came across a website that suggested that Dr Covenant can help get ex back fast. So, I felt I should give him a try. I contacted him and he told me what to do and i did it then he did a Love spell for me. 18 hours later, my husband really called me and told me that he miss me and the kids so much, So Amazing!! So that was how he came back that same day,with lots of love and joy,and he apologized for his mistake,and for the pain he caused me and the kids. Then from that day,our Marriage was now stronger than how it were before, All thanks to Dr Covenant, he is so powerful and i decided to share my story on the internet that Dr.covenant real and powerful spell caster who i will always pray to live long to help his children in the time of trouble, if you are here and you need your Ex back or your husband moved to another woman, do not cry anymore, contact this powerful spell caster now. Here’s his contact
    WhatsApp: +2349057353987 ,
    Email: covenantsolutiontemple@gmail.com,
    Website:https://covenantspelltemple.blogspot.com .

    ReplyDelete
  41. God bless Dr Alabi for his marvelous work in my life,I was diagnosed of HERPES since 2015 and I was taking my
    medications, I wasn't satisfied i needed to get the HERPES out of my
    system, I searched about some possible cure for HERPES i saw a comment
    about Dr Alabi how he cured HERPES with his herbal medicine, I contacted
    him and he guided me. I asked for solutions, he started the remedy for my
    health, he sent me the medicine through UPS SPEED POST. I took the medicine
    as prescribed by him and 14 days later i was cured from HERPES, Dr.Alabi
    truly you are great, do you need his help also? Why don't you contact him
    through dr.alabiherbalhome@gmail.com or his WEBSITE http://dralabiherbalhome.blogspot.com, you can as well contact him on whatsapp +2348115204568
    HE CAN AS WELL CURE THE FOLLOWING DISEASE:- 1. HIV/AIDS 2. CANCER
    4. ALS 5. Hepatitis B 6. Diabetes Athrux, scabies

    ReplyDelete
  42. OMG! Thank you so much Dr. OCUSODO for restoring back my Broken marriage for 3 years of total separation with my lovely husband cos of her mistress who use a spell on him to abandoned me and our kids. i have contacted so many casters online several times but be scammed. i saw a testimony on the internet of one Juliet testifying of your good work, i contacted you which you assured me just 48 hours for an instant result. Sir just same 48 hours as you promise my husband came back home begging for forgiveness to love and cherish i and the kids forever, am so happy and thankful to you Dr. OCUSODO,,,I am So Happy and Excited because as i am writing this Testimony, My husband is madly in love with me again. If there is any body Out there who is in Difficulties and need help should kindly Contact Dr. OCUSODO on His Email ID and he is Ready to Help you no matter the Situation,{drocusodospellcaster@gmail.com] or [drocusodospellcaster@yahoo.com] or WhatsApp or call him now: +2349067457724

    ReplyDelete
  43. Very useful information for people, I think this is what everyone needs.

    ReplyDelete
  44. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David
    Clara I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is David Sandra I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the root and half to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man for my
    younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me

    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com/ drsakuraspellalter.wordpress.com or whatsapp him
    +2348110114739 you can follow him up on instagram herbalist sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com

    ReplyDelete
  45. Dr Ben herbal medication that cure Herpes and HPV For any help whatsApp him on +2347064294395

    its a pleure for me to write this testimony about this wonderful thing that happened to me last month on how i got cured from Herpes i have been reading so-many post of some people who were cured of Herpes, but i never believed them, I was hurt and depressed so I was too curious and wanted to try Dr Ben then i contacted him on his email when i contact him, i never thought possible that Dr Ben can Really cure herpes i never really believed in Herbal medication but I played along with a little hope and faith and after everything but Dr Ben changed my life and made me a true believer and today i am living haply with my wife and kid you can contact him to get your herpes medication and live healthy again on

    Benherbalcure@gmail.com
    https://benherbalcure.webs.com/
    WhatsApp +2347064294395

    ReplyDelete
  46. I was in trouble when my doctor told me that I have been diagnosed with HERPES and I know my family will face a serious problem when I am gone I lost hope and wept most of the time, but one day I was browing through the internet when I saw Dr. Omolowa herbal home contact number online I called him and he guided me. I asked him for solutions and he started the remedy for my health thank God, now everything is fine I am cured by Dr.Omolowa herbal medicine am very thankful to Dr. Omolowa and very happy with my hobby and family email him on (dr.omolowa@gmial.com) CALL/WHATSAPP +2349039377739 can as well cure the following disease;
    Herpes, Asthma, Cancer, HSV1, & HSV2, Diabities , HIV/AID GENITAL WARTS, GENITAL HERPES,HSV 1AND2 ETC.
    Have a nice day.

    ReplyDelete
  47. Healing from HIV-AIDS, i never though dr.camala who could ever get my HIV-AIDS cured with his healing spell, i have tried almost everything but i couldn't find any solution on my disease, despite all these happening to me, i always spend alot to buy a HIV drugs from hospital and taking some several medications but no relieve, until one day i was just browsing on the internet when i come across a great post of !Michelle! who truly said that she was been diagnose with HIV and was healed that very week through the help of these great powerful healing spell doctor, sometime i really wonder why people called him Papa camala, i never knew it was all because of the great and perfect work that he has been doing that is causing all this. so i quickly contacted him, and he ask me some few questions and he said a thing i will never forget that anyone who contacted him is ! always getting his or her healing in just 6 hours after doing all he ask you, so i was amazed all the time i heard that from him, so i did all things only to see that at the very day which he said i will be healed, all the strength that has left me before rush back and i becomes very strong and healthy, this disease almost kills my life all because of me, so i will to hospital to give the final test to the disease and the doctor said i am HIV negative, i am very amazed and happy about the healing dr.camala gave to me from the ancient part of Africa, you can email him now for your own healing too at: dr.camalahivadscure@yahoo.com or WhatsApp him +2349055637784 thank you sir for healing me from HIV, i am Doris Carter.

    ReplyDelete
    Replies
    1. It’s obvious some patient with HERPES/HIV/CANCER are been enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2012 until I was introduce by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr Jones herbal Medicine. This is a year and 2 weeks since I was delivered from Herpes. All thanks to God for using this Great herbalist to heal me. I have promise to keep telling good about Dr jones. Please fill free to share Your problems with him and don’t forget to tell him I did refer you to Him. Thanks. Write him on mail bantespelltemple@gmail.com or WhatsApp him on +2347059073543. He deals with Alzheimer virus, Copd, Cancer HIV Herpes Genital warts ALS BV UTI Virginal infection Genital Wart HPV Hepatitis A/B Good luck HSV Pregnancy Ex back

      Delete
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    ReplyDelete
  49. When I found Dr. ABAKA I was in desperate need of bringing my ex lover back. He left me for another woman. It happened so fast and I had no say in the situation at all. He just dumped me after 3 years with no explanation. I contact Dr.ABAKA through his website and He told me me what i need to do before he can help me and i did what he told me to, after i provided what he wanted, he cast a love spell to help us get back together. Shortly after he did his spell, my boyfriend started texting me again and felt horrible for what he just put me through. He said that I was the most important person in his life and he knows that now. We moved in together and he was more open to me than before and he started spending more time with me than before. Ever since Dr. ABAKA helped me, my partner is very stable, faithful and closer to me than before. I highly recommends Dr. ABAKA to anyone in need of help. Email: drabakaspelltemple@gmail.com, Call him or add him on whatsapp via: +2349063230051/https://drabakaspelltemple.blogspot.com

    ReplyDelete
  50. Greetings to every one here. I want to let every one know that Hiv/AIDS is a serious and deadly disease which can't be cured through drugs or injections by the American doctors but the best way to deal with HIV/AIDS is by taking natural herbs medicine for it to flushes out the virus and is only few American doctors that know about this herbal medicine from doctor adelli a great herbalist doctor. I have read about Dr adelli the great herbalist doctor from African who can cure HPV with his powerful herbal medicine. for the people suffering from the following diseases Epilepsy, Hiv, Herpes, Cancer, Als, Hepatitis, Diabetes, Hpv,Infections ETC should contact him for his herbal medicine because his herbal medicine cured all kinds of diseases or virus, i am telling you all this because i am a living testimony and i was cured of Hpv. and my child was cured of epilepsy. Although, i sent him what he requested and he sent me his medicine which i took for two weeks and today when i went for test i was tested Hpv negative. you can reach him through his email on(dradelliherbalhome@gmail.com)And you can also whatsapp/call him through his number(+2348146240081)

    ReplyDelete
  51. I GOT CURED FROM HERPES,AFTER USING DR INIBOKU HERBAL MEDICINE.

    I caught genital herpes from my ex boyfriend who never had any symptoms. I have had it for 4 months now,and it has affected my life. I have told my husband who I trusted about it and I have never had a bad reaction, it has affected my new relationships with my husband. People think herpes is really a minor skin irritation herpes has a long term effects on health. The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another. I would like to advise people on how i get rid of my herpes.i was reading a comment on the internet,and i saw a testimony posted by a woman from island that she get rid of her herpes with the help of doctor iniboku. so i was so happy when i saw that post,that his herbal medication is free.i quickly collect the herbal doctor email and i email him within 5 hr he respond to my email.i explain things to him he told me not to worry that i should fill his herbal form wish i did.he only request for little money that he will use to buy the items for the preparation of the herbal medicine,wish i send to him because the pain was too much for me to bear.after some days he told me that he has prepare the herbal medicine,that i should send him my address that he want to sent it to me via DHL or FED-EX that was how i got the herbal medication.and i use it as i was told.after few days i found out that my herpes was no more.when some of my friend who has herpes saw me they were surprise and i also introduce them to the man and they are also cure from the same herpes.if you have herpes,kindly contact doctor iniboku via this email drinibokuspelltemple@gmail.com or whatsapp +2347059186346

    ReplyDelete
  52. It just occur to me that I have not done the right thing since when my husband came back to me, I am on this blog to give thanks to whom it deserve, Some couples of weeks ago my life was in a terrible shape because my husband left me and I never believe that I was going to get him back, But through the help of this powerful spell caster called Dr.Ekpen my life is now in a joyful mood, I must recommend the services of Dr.Ekpen to anyone out there that they should contact Dr.Ekpen through these details below: ( ekpentemple@gmail.com ) or whatsapp +2347050270218 because through Dr.Ekpen assistance my marriage was restored.

    ReplyDelete
  53. HPV cure with the help of a herbal medication by Dr Ben for help contact now to get your own cure

    I think this site is useful in all that is suffering from HPV can show it to their friends and family and then there is a greater understanding I don't just know the reason why some people are finding it difficult to believe that, there is a cure for HPV, I have been suffering from HPV since 9month now but today I am happy that i am cure from it with the herbal medicine of Dr.Ben the great healer sent to me,I was browsing the internet searching for help when I came across a testimony shared by someone on how Dr.Ben cure his HPV I was so much in need of getting his treatment so I contacted Dr.Ben for the HPV cure.I am so much happy today that we have someone like this great herbal Dr Ben who has the cure to all types of virus contact Dr Ben on email address:


    Benherbalcure@gmail.com
    WhatsApp +2347064294395
    Website http://benherbalcure.webs.com/

    ReplyDelete

  54. I was in trouble when my doctor told me that i have been diagnosed with
    herpes and i know my family will face a serious problem . when i am gone i
    lost hope and wept most of the time, but one day i was surfing the internet
    i saw Dr. omohan herbal home contact number online i called him and he
    guided me. i asked him for solutions and he started the remedy for my
    health thank God,now everything is fine i am cured by Dr. omohan herbal
    medicine am very thankful to Dr. omohan and very happy with my hobby and
    family email him on (dromohanherbalmedicine@gmail.com) call/whatsapp number +2348164816038

    He can as well cure the following disease;

    Herpes,
    Asthma,
    Cancer,
    HSV1, &
    HSV2,
    Hepatitis B,
    HIV/AID ETC.

    ReplyDelete
  55. I contacted Mr. Femi okuns, after wasting time on other so called witches & spell-casters. I spent thousands of dollars with no results. Up to the point where I contacted via email: homeofspells.247@gmail.com I had No contact with my lost love,my husband whom he helped to bring back to me permanently.I realized Dr was special, because,the day and moment i sent our details,He asked me to call my husband, after two months of No contact at all.from that point,everything changed,now my husband is back to me.
    Mr. Femi has since cast 3 different spells for my friends and all are working fine.the days whilst he is performing the spells, He is there, as he says on his site 24/7. I live in the UK, and the time difference makes it difficult to keep in touch within reasonable hours, but he is always willing to listen and cast spells.
    I am confident that the results you wish for will manifest when you contact Mr. Femi okuns,via email: homeofspells.247@gmail.com. I want to share my testimony he is more than a wizard, he is a friend, mentor and spiritual spell-caster today
    1. Spell for magic
    2. Spell for exam success
    3. Spell for kidney problem
    4.Spell for H.I.V and AIDS
    5.Spell for cancer
    6. Spell to keep your job secure
    7.Spell to get a job
    8.Spell to get a husband
    9.Spell to get your child from your ex
    10.Spell for stroke
    11.Spell for your ex to be submissive to you
    12.Spell for you to get back your ex
    13.Spell to stop your ex from drunkenness
    14.Spell for asthma
    15.Spell for weak ejaculation
    16.Spell for pile
    17.Spell for fibrous

    ReplyDelete

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What are your thoughts? Any similar experiences? Want to talk about something?