Angiovac

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caligas said:
Anyone doing these for valve vegetation?

Any thoughts/observations/commentary?
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I’ve seen the aftermath. Not great evidence for it but offers a more viable option for these people than open surgery since they are sick as ****. One case perforated something and had to covert to a sternotomy for pericardial bleed once but he had vegetations on all 4 valves so maybe that was why. Outcomes on these folks are horrible but the alternative is to let them die and we can’t have that :/
 
Great if it goes well. Not great if it doesn’t. Predictive values for an okay time: good surgeon who knows his limits. Bad time? Vice versa. Plan accordingly.

I’ve done some with an art line and two PIVs, others with big lines ready to crash on.
 
caligas said:
Anyone doing these for valve vegetation?

Any thoughts/observations/commentary?
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Most we have done have been on younger, "healthier" drug addicts. Almost never on any pressors prior to the anesthetic. Usually don't require much after induction either. Generally 2 "big" peripheral lines and an a-line. Personally, I enjoy watching the clot get chewed up on the echo. Thankful we have a couple of our best surgeons doing these cases.
 
chessknt said:
I’ve seen the aftermath. Not great evidence for it but offers a more viable option for these people than open surgery since they are sick as ****. One case perforated something and had to covert to a sternotomy for pericardial bleed once but he had vegetations on all 4 valves so maybe that was why. Outcomes on these folks are horrible but the alternative is to let them die and we can’t have that :/
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If all 4 valves are hosed, why undertake a likely unsuccessful and expensive treatment plan and just, you know, talk to the family and patient about realistic expectations and avoid unnecessary interventions?
 
2Fast2Des said:
If all 4 valves are hosed, why undertake a likely unsuccessful and expensive treatment plan and just, you know, talk to the family and patient about realistic expectations and avoid unnecessary interventions?
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Had a trached patient on a vent that looked like a balloon. Chilling on the floor after a long icu stint. 30 years old, had two valves replaced recently after ruining them with iv drugs. Continued using drugs after valves were replaced and now all four valves are bad. Talked to them about realistic expectations, "I want everything done for my honey".
 
GassYous said:
Had a trached patient on a vent that looked like a balloon. Chilling on the floor after a long icu stint. 30 years old, had two valves replaced recently after ruining them with iv drugs. Continued using drugs after valves were replaced and now all four valves are bad. Talked to them about realistic expectations, "I want everything done for my honey".
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Then let them foot the bill, I'm sure their opinions will change drastically. Reminds me of a story I heard, Doctor tells a family that their old granny needs X surgery\treatment, family says of course do everything you can. But when it came to question of how it would be paid, they had to foot the bill, turned into hey hey she lived a good life no need to let her suffer 😂
 
GassYous said:
Had a trached patient on a vent that looked like a balloon. Chilling on the floor after a long icu stint. 30 years old, had two valves replaced recently after ruining them with iv drugs. Continued using drugs after valves were replaced and now all four valves are bad. Talked to them about realistic expectations, "I want everything done for my honey".
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1642610809447.jpeg
 
2Fast2Des said:
If all 4 valves are hosed, why undertake a likely unsuccessful and expensive treatment plan and just, you know, talk to the family and patient about realistic expectations and avoid unnecessary interventions?
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She actually survived…

I don’t disagree with you but when the surrogate is a drug enabling parent what can I do? Surgeon is saying he’ll do it and mom says full code all forms of care no matter the futility. In America if I say no and refuse to do it I’ve committed instant malpractice under abandonment.
 
2Fast2Des said:
Then let them foot the bill, I'm sure their opinions will change drastically. Reminds me of a story I heard, Doctor tells a family that their old granny needs X surgery\treatment, family says of course do everything you can. But when it came to question of how it would be paid, they had to foot the bill, turned into hey hey she lived a good life no need to let her suffer 😂
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I encountered this when a family wanted me to Trach an 80 year old with anoxic brain injury. I told them no facility would take him after we do the Trach so he has to go home to live with them and behold they can’t possibly do that since they all live in trailers so I need to figure something else out. Trach still done but now he just lives in the icu forever racking up an enormous Medicare bill. Best healthcare in the world right here.
 
chessknt said:
She actually survived…

I don’t disagree with you but when the surrogate is a drug enabling parent what can I do? Surgeon is saying he’ll do it and mom says full code all forms of care no matter the futility. In America if I say no and refuse to do it I’ve committed instant malpractice under abandonment.
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The problem therein lies the surgeon as well. I thought surgeons would avoid high risk cases like that to avoid affecting their mortality\morbidity metrics
 
chessknt said:
She actually survived…

I don’t disagree with you but when the surrogate is a drug enabling parent what can I do? Surgeon is saying he’ll do it and mom says full code all forms of care no matter the futility. In America if I say no and refuse to do it I’ve committed instant malpractice under abandonment.
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How can it be malpractice? You have no duty to the patient until you begin care.

How can it be abandonment? You were never the patient's physician.

The surgeon consults you for an evaluation of the patient's suitability for anesthesia. You can say I don't recommend surgery for this patient and sign off.

Sure, there are 11 different ways that can adversely impact your job and career, if you upset a surgeon, hospital administrator, or your own group, but it's not malpractice to disagree with a treatment plan when consulted for a non-emergency procedure, thank you for this interesting consult, please feel free to consult us again if the patient's condition changes.
 
pgg said:
How can it be malpractice? You have no duty to the patient until you begin care.

How can it be abandonment? You were never the patient's physician.

The surgeon consults you for an evaluation of the patient's suitability for anesthesia. You can say I don't recommend surgery for this patient and sign off.

Sure, there are 11 different ways that can adversely impact your job and career, if you upset a surgeon, hospital administrator, or your own group, but it's not malpractice to disagree with a treatment plan when consulted for a non-emergency procedure, thank you for this interesting consult, please feel free to consult us again if the patient's condition changes.
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I think refusing to provide care qualifies… she was going to die if something didn’t get done because antibiotics aren’t working and she has had positive cultures for 2 weeks with metastatic disease everywhere, surgeon says he will do it, then you come in and say nah just let her die? I have literally never seen this anywhere I have worked.

It isn’t my decision anyways, I’m just in the icu trying to corral the cats. But if a family says they want cpr done and I tell them it is futile and don’t do cpr I have a guaranteed lawsuit on my hands. Might be technically right but that has never mattered where the law is concerned for us.
 
chessknt said:
I don’t disagree with you but when the surrogate is a drug enabling parent what can I do? Surgeon is saying he’ll do it and mom says full code all forms of care no matter the futility. In America if I say no and refuse to do it I’ve committed instant malpractice under abandonment.
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full code says if their heart stops we will code them. If they want everything done, that's fine, but the surgeon doesn't have to offer them anything in particular if they do not feel risk outweighs benefit. You don't put a transvenous pacemaker in when a patient with massive head trauma/bleed and midline shift goes asystolic. I mean you might push some epi and do some chest compressions, but that's about it.
 
chessknt said:
I encountered this when a family wanted me to Trach an 80 year old with anoxic brain injury. I told them no facility would take him after we do the Trach so he has to go home to live with them and behold they can’t possibly do that since they all live in trailers so I need to figure something else out. Trach still done but now he just lives in the icu forever racking up an enormous Medicare bill. Best healthcare in the world right here.
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Who did the trach?
 
chessknt said:
G

A general surgeon at bedside. Family was never going to agree to let him aspirate to death so off we went in to the land of endless medical care on someone else’s dime.
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He sounds like an idiot. Nobody can force him to trach, but I guess he did anyway.
 
Have done Angiovac for tumor thrombus and right sided endocarditis. I usually have a TEE in, but not everyone do that. I've caught venous air, from negative pressure cavitation. I think debunking is probably the best case scenario for endocarditis. Love how the cardiologists fist bumps after some clot/mass comes out. I guess it better than nothing after the surgeons turned them down.
 
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