Trust no one.....
The central line insertion
was definitely a heart pounding procedure for a medical trainee during the first
few years of their training. The localization of the central vein is the most challenging
part especially for patient with thick adipose tissue.
The introduction
of ultrasound into ED practice had eased the process and raised the successful
rate of central line catheterization.
Most of my young
colleagues practice the actual ultrasound guided method, but I usually used the
ultrasound to confirmed the position of vein and proceed with the procedure
using the traditional method. We got a small amount of incentive if we use
ultrasound to guide our catheterization. I am more confident during the venous
puncture part as the imaging had given me a rough idea of the position and size
of the vein.
The catheterization was always a one man show until recent few years, the head of department had wanted the surgical aide to assist in the procedure as someone would need to hold the probe during the puncture. Well, as I did not use the probe during the puncture, frankly said, I am not very particular about having an assistant. However with an assistant, the secure with stitches part would usually be done by the aide and I would left the scenario early after fully insertion of the catheter.
I did remember in
the past that one of my senior had told me that when the catheter is inserted down the guide
wire, we would need to make sure that the tail of the wire is visualized and properly grabbed hold on so that the wire is not fully inserted into the center vein which might need a vascular
surgery to extract out the wire.
I had always being
cautious and would teach my staff that the tail of the wire needed to be secured
by the operator before the catheter is fully inserted.
All of our
surgical aides knew the rules as I had always insisted that part is clearly done.
However, few
months ago, one of our junior colleague had met the worst case scenario above
mentioned.
It was an easy
femoral puncture and our junior colleague had left the table prematurely after
the guide wire was being inserted. The insertion of catheter was left alone to our senior surgical aide. The wire was not secured before the catheter was inserted. When
the aide noted the wire is not seen at the tail of the catheter; he got panic
and removed the catheter immediately; the act had left the wire fully inside the
femoral vein. What he should have done is to clamp the catheter with a forceps
and remove the catheter hoping the wire would be removed with the catheter.
When notified, our junior
colleague however was bold enough to do a small cut down with the aid from the
senior surgical aide. The wire was noted and removed from the femoral vein without complication.
It was a heart
pumping scenario which was compensated without a scratch.
When my junior
colleague told me about the incident, both of us sighed and agreed that it was an
narrow escape.
The surgical aide
was senior enough and capable enough to perform many procedures ….but yet
accident do happens..
My conclusion
-----“Trust no one”
Source:
Trust no one.....
