[HSF] Intimal Tears

[Ani Anyanwu]

Yes Hal you are right. Only three weeks ago I had a patient in ARDs on PEEP 16 who had a *subclavian* line placed and you can guess what happened - cardiac arrest, CPR etc etc  a tension pneumothorax in an already hypoxic patient is a very dire complication indeed. The week before I rescued a patient with an LVAD who was about to have another subclavian line placed by a PA while still on a heparin drip with APTT 85. We have line policies etc etc but as with other policies, they are only as good as the operator. In the earlier case I mentioned a CXR was done and 'confirmed' adequate placement and even when the patient was having seizures the treatment was to give antiepileptics into the same line and more seizures. 
 
An invariable consequence of a training program is that these line related complications will be seen more frequently and when they occur are less likely to be recognized and dealt with promptly. If you believe Medicare data, medical errors are amongst the leading causes of morbidity and mortality in hospital which is partly why no procedure should be taken lightly and like with surgery, one must factor in who is doing a procedure into the decision making process.
 
Ani
 



> From: Hgrmd at aol.com> Date: Mon, 4 Feb 2008 20:33:16 -0500> Subject: Re: [HSF] Intimal Tears> To: OpenHeart-L at lists.hsforum.com> CC: > > Ani,> Though I'm sure it's not been examined, I would bet you that teaching > institutions have proportionately more M and M with lines than would be found in > the typical private practice setting. While a chief resident in general > surgery many years ago, I had an intern who fatally lacerated a subclavian artery > with a central line needle. Changing the angle of the needle while it is > deep in the neck or chest is the presumed mechanism. > Academics and private practice settings have their pros and cons. Having > a resident readily available at 2 in the morning is offset by the danger of a > new resident with a big needle.> > Hal> > > > **************Biggest Grammy Award surprises of all time on AOL Music. > (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025> 48)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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