Preop lines

[GassYous]

Of course. I don't know if you have travelers in your shop yet, but my experience so far is that they could give a **** about local culture or respect. They're on to the next in 3 weeks.

Or alternatively I could deal with none of this and place lines in the comfort of my line/block area with a sedated patient.

Actually I loved our travelers. And that would give me a lower threshold to tell them what's up

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[Beeftenderloin]

Re lumbar drain. That actually makes sense. And done probably because a bloody tap would delay the surgery.

This is standard practice for TAAA where I’m at, for that exact reason. But just for the lumbar drain. Art line done in pre-op. Introducer + PAC after asleep in OR.

 

[coffeebythelake]

its funny you say this, but europe has induction rooms where you do place preop ETT and then bring them into the OR

Wonder how that works when you have a 350 lb fatty? Basically half my patient population. You tube them on their stretcher then transfer them over to the OR table? My back wouldn't handle that every day.

 

[McPoyle]

Re lumbar drain. That actually makes sense. And done probably because a bloody tap would delay the surgery.

I disagree. Doing it in the morning doesn’t increase the odds of complication. Plus it’s just needless exposure to infection risk. Sure, small, but indefensible given they didn’t need the drain yesterday.

 

[coffeebythelake]

I disagree. Doing it in the morning doesn’t increase the odds of complication. Plus it’s just needless exposure to infection risk. Sure, small, but indefensible given they didn’t need the drain yesterday.

How long do you typically delay the case if you have a frankly blood tap? In a case that requires systemic heparinization?

The risk for a spinal hematoma is much greater than your concern about infection from leaving a catheter in a few extra hours. Add on top of wasting OR resources and staffing when the case is cancelled. Clearly a bunch of people in your surgical and anesthesia department recognize that thought process.

 

[Lecithin5]

I disagree. Doing it in the morning doesn’t increase the odds of complication. Plus it’s just needless exposure to infection risk. Sure, small, but indefensible given they didn’t need the drain yesterday.

I think you can argue this as well. But I still would prefer an admission the day before for the drain to be placed by IR- (hopefully) a single poke under fluoro, thus reducing the risk of bloody return. And if bloody etc, you postpone. Yes, of course we can do it ourselves the day of, and if pt not too big, should be no problem. But these days nothing is a slam dunk, between obesity and/or arthritic changes etc.

 

[McPoyle]

How long do you typically delay the case if you have a frankly blood tap? In a case that requires systemic heparinization?

The risk for a spinal hematoma is much greater than your concern about infection from leaving a catheter in a few extra hours. Add on top of wasting OR resources and staffing when the case is cancelled. Clearly a bunch of people in your surgical and anesthesia department recognize that thought process.

These patients were not getting systemic heparinization, not CPB dosing at least given lack of CPB. There’s no way an extra night of hospitalization with extra risk of infection is worth the cost in light of low incidence of traumatic drain placement. My current gig we don’t do this, we do lines and drains in the OR day of surgery, luckily a bunch of people in our surgical and anesthesia department recognize this thought process.

 

[Lecithin5]

These patients were not getting systemic heparinization, not CPB dosing at least given lack of CPB. There’s no way an extra night of hospitalization with extra risk of infection is worth the cost in light of low incidence of traumatic drain placement. My current gig we don’t do this, we do lines and drains in the OR day of surgery, luckily a bunch of people in our surgical and anesthesia department recognize this thought process.

Although I don’t know the stats, I imagine the risk of an infection is overstated. But a bloody tap is probably unlikely (but probably more likely than an infection from a drain that’s been in for less than a day?). Myself and my partners haven’t had to cancel a case for this over the years, knock on wood. Cost of an admission shouldn’t be much of a factor given the large cost of the operation itself. We do all lines as well immediately preop, although we wish the drain was done beforehand, as some centers do.

As I said above, you can argue both ways.

 

[coffeebythelake]

These patients were not getting systemic heparinization, not CPB dosing at least given lack of CPB. There’s no way an extra night of hospitalization with extra risk of infection is worth the cost in light of low incidence of traumatic drain placement. My current gig we don’t do this, we do lines and drains in the OR day of surgery, luckily a bunch of people in our surgical and anesthesia department recognize this thought process.

What you describe is the same in my hospital. We do the lumbar drain on day of surgery. We've also had cases cancel for bloody taps. So as long as you know what you get yourself into then so be it.

I didn't say I agree with the practice of performing the drains day before surgery, what I said was that I understand why some places would do it that way. You, however seem to think there is only one right way.

TEVARs for which lumbar drains are often performed get systemic heparinization. Period. Or perhaps you think that only CPB level heparinization is systemic heparinization?

Still waiting for your stats about infection risk.

 

[McPoyle]

What you describe is the same in my hospital. We do the lumbar drain on day of surgery. We've also had cases cancel for bloody taps. So as long as you know what you get yourself into then so be it.

I didn't say I agree with the practice of performing the drains day before surgery, what I said was that I understand why some places would do it that way. You, however seem to think there is only one right way.

TEVARs for which lumbar drains are often performed get systemic heparinization. Period. Or perhaps you think that only CPB level heparinization is systemic heparinization?

Still waiting for your stats about infection risk.

I never said the infection risk was high, just unnecessary to simply save time. Same with the cost of the admission, sure one more night probably won’t break the bank but it’s unnecessary. Though in the three centers I’ve been at, a drain would require an ICU admission which isn’t cheap, and seems avoidable but just doing the lines/drains when the patient actually needed them.

 

[nimbus]

Although I don’t know the stats, I imagine the risk of an infection is overstated. But a bloody tap is probably unlikely (but probably more likely than an infection from a drain that’s been in for less than a day?). Myself and my partners haven’t had to cancel a case for this over the years, knock on wood. Cost of an admission shouldn’t be much of a factor given the large cost of the operation itself. We do all lines as well immediately preop, although we wish the drain was done beforehand, as some centers do.

As I said above, you can argue both ways.

Same. Except for the big Samoan guy I mentioned above, all our TEVARs have gotten their lumbar drains in the OR on the day of surgery. We don’t do a huge number, maybe 6-12/year, but we haven’t had to postpone a single one for a bloody tap in the 10+ years we’ve been doing them. The incidence of bloody taps and infection are both probably very low.