AW: AW: [HSF] Intimal Tears-Human error

[Dr. Roberto Battellini]

Tea,
Omit is better, but if not, we must admit for ourselves. I did not mean to
give opinion, we agree with you we should describe only findings.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Tea Acuff
Gesendet: Sonntag, 3. Februar 2008 23:05
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: AW: [HSF] Intimal Tears

Did you mean omit or admit? 
I think all you have to do is describe, either that you found the bleeding
and stopped it, or if you like where the bleeding was from. You don't have
to give an opinion as to how it came about. Opinions are not as objective as
findings. If you are pressed answer truthfully your opinion and just add
that it is a described occurence after such procedure, which is again the
truth without specualtion.

tea


----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, February 3, 2008 10:23:25 AM
Subject: AW: [HSF] Intimal Tears

Giuseppe,
I had the same experience twice. But if you open the pleura and look at the
haematoma, you will recognize the problem. Of course, the one who put the
catheter will not...It is a not uncommon complication of jugular indwelling
catheters.
I agree, it is better for the patient to admit errors.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Macbook
Gesendet: Sonntag, 3. Februar 2008 16:32
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Intimal Tears

Nasser,

two weeks ago a did an AVR + PFO closure in a quite young woman  
(about 50). My resident opened the patient and did a large opening of  
the right pleura. At the end of the procedure I sucked almost 1 liter  
of blood from the right pleural cavity (I said to myself that this  
was blood collected during the operation). The day after the patient  
was extubated and well but there was still some bleeding from the  
right chest tube. The patient was reexplored by a collegue who found  
nothing. The patient continued to bleed and on postop day 2 I  
reexplored the woman. I found a bleeding spot from the apex of the  
parietal pleura. It was clearly related to the IJV catheter but the  
anesthesist said that it was related to surgery!!! BTW I put two  
stitches and stopped the bleeding. However, as the blood was quite  
red and I was worried about an arterial lesion I asked the vascular  
surgeon to do an intraoperative arteriography that was negative. The  
patient luckily did very well. We all make mistakes but it is nice to  
admit them.

Giuseppe


Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto:

> "Frankly, I'm surprised I've never encountered this complication  
> until now"
>
> Hal
> That adds to your critical observance as a surgeon, recognizing the  
> fault
> first time seeing it. I faced that situation before in a 55 y old  
> female
> having a straight forwards Mitral repair. everything went smoothly  
> yet there
> was some bleeding welling up in the pericardium, that we could not  
> come off
> bypass ........ all manouvres to find out the source of bleeding were
> evading ..... blood seemed to come from around the SVC upper part,  
> where
> nothing was ever touched .... patient passed off after some 5 hours on
> bypass and blood thinning out. On table autopsy, I dissected around  
> the SVC
> up to the IJV.... to find the whole area bathing in blood,  
> ecchymosed ....
> and blood perculating through the wall of the vein .. down the  
> sheath ....
> around the SVC ..... into the pericardium .. !! .... opening the vein
> longitudinally, multiple non peneterating longitudinal tears were  
> found in
> the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly
> appointed anaesthesiologist tried many times before securing the  
> IJV cannula
> in place .... as usual ... mortality was ascribed to the  
> surgeon .... !!!!
> ... a new lesson with a hard price ..!! .. never forgotten ..
>
> NFA
>
>
>
>
>
>
> On Jan 31, 2008 7:09 PM, <Hgrmd at aol.com> wrote:
>
>> Don,
>>  My assistant is pretty strong, but I'm not blaming him.    
>> Frankly, I'm
>> surprised I've never encountered this complication until now.
>>
>> Hal
>>
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