Complications

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lymphocyte

lymphocyte

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10+ Year Member
Physician
I won't go into too many details, but I've gone through it my head about a hundred times. I was putting in temporary pacing wires via a femoral approach. Ultrasound guided for the puncture and the fluro for the rest. Cardiologist scrubbed with me. Seemed to go well. Patient ended to with a retroperitoneal haematoma the next day and almost coded. I feel like dog **** 😞. I've put in I dunno how many femoral lines and about 20 temporary pacing wires with no real complications until now.

Our director put his hand on my shoulders and said, "intensive care is a contact sport." He left it at that. ****.
 
lymphocyte said:
I won't go into too many details, but I've gone through it my head about a hundred times. I was putting in temporary pacing wires via a femoral approach. Ultrasound guided for the puncture and the fluro for the rest. Cardiologist scrubbed with me. Seemed to go well. Patient ended to with a retroperitoneal haematoma the next day and almost coded. I feel like dog **** 😞. I've put in I dunno how many femoral lines and about 20 temporary pacing wires with no real complications until now.

Our director put his hand on my shoulders and said, "intensive care is a contact sport." He left it at that. ****.
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Sorry to hear that happened to you. But **** happens. I was putting a chest tube on a COVID patient last month and as soon as I inserted, there was massive bleeding through the tube. Chest tube looked like an ECMO cannula. It was on the right side so I don’t think I was in the heart. Don’t know what happened. I did massive transfusion, performed good CPR . But patient bled to death. It was ****ing horrible. I had to put a chest tube in that same room again earlier this week.

I am curious about the circumstances surrounding your situation. I’m assuming you’re CCM? In what situation did you need to put a femoral approach pacer as an intensivist? In the Cath lab? Or fluoro at the bedside?
 
CCM-MD said:
Sorry to hear that happened to you. But **** happens. I was putting a chest tube on a COVID patient last month and as soon as I inserted, there was massive bleeding through the tube. Chest tube looked like an ECMO cannula. It was on the right side so I don’t think I was in the heart. Don’t know what happened. I did massive transfusion, performed good CPR . But patient bled to death. It was ****ing horrible. I had to put a chest tube in that same room again earlier this week.

I am curious about the circumstances surrounding your situation. I’m assuming you’re CCM? In what situation did you need to put a femoral approach pacer as an intensivist? In the Cath lab? Or fluoro at the bedside?
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I appreciate that, thank you.

Still training CCM. Patient had tachy-brady syndrome with recurrent syncope. Needed to go to the mothership for a PPM. Retrieval didn't want to take them without temporary pacing wires, which seemed both reasonable and unnecessary at the same time (we thought they could manage with T/C pacing if needed but also probably not ideal in the sky).

We have a cardiologist who does them via femoral with fluro at the beside. Works really well, and that's how I've learnt. He's a a great mentor and calls me in for these or pericardiocentesis. He was scrubbed in with me.
 
We cause harm with our MDM not infrequently but the detachment when it's not a procedure is just easier to disconnect from. The obvious and irrefutable connection to the complication when it's from a procedure is burdensome. Just hits way harder. Respect to surgeons and proceduralists for this. But ultimately **** happens. Retrospect and learn from it if there are lessons to be learned. If there aren't there aren't. But don't let it get in your head too much
 
lymphocyte said:
I won't go into too many details, but I've gone through it my head about a hundred times. I was putting in temporary pacing wires via a femoral approach. Ultrasound guided for the puncture and the fluro for the rest. Cardiologist scrubbed with me. Seemed to go well. Patient ended to with a retroperitoneal haematoma the next day and almost coded. I feel like dog **** 😞. I've put in I dunno how many femoral lines and about 20 temporary pacing wires with no real complications until now.

Our director put his hand on my shoulders and said, "intensive care is a contact sport." He left it at that. ****.
Click to expand...
Anesthesiologist here. Sure you had a complication but that is the price of doing business. Probably poor protoplasm, poor vessels, you know the drill. I know experienced vascular surgeons who have had access screwups as well. When you screw up something that is 100% within your control (a preventable mistake), you need to seriously self-reflect. Not so much this time.
 
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