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Discussion in 'Surgery and Surgical Subspecialties' started by SLUser11, Apr 28, 2007.

  1. SLUser11

    SLUser11 CRS
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    Med student gets needle stick when unsupervised sewing in a central line

    In this thread, a med student complains about getting stuck with a keith needle when sewing in a central line, and as she gives more information, I find that:

    1. Her resident left the room, and she was unsupervised.

    2. She was unfamiliar with the keith needle, and from the sound of it, had never actually done a central line before.

    3. The resident insisted that she use the straight needle after she asked for a needle driver and curved needle (likely showing that she'd never even seen a central line put in before).

    4. After contaminating herself, the student finished sewing in the line.

    5. The student initially didn't report the stick.




    ARE YOU KIDDING ME? Is it me or did the resident (an intern, by the way) really drop the ball here? He/she didn't spend any time going over how to use the keith needle safely, then left the room completely to let the student wing it.

    The student went along with this crap, likely out of a combination of over-ambition and fear of asking "stupid questions," two extremely common student traits.

    There are many other things that could have gone wrong that didn't, such as tagging the catheter with the needle, dressing the site incorrectly, the patient being high risk for HIV/Hep C, etc. To me, this behavior just seems completely unacceptable.

    I've worked in hospitals with a great deal of student and resident autonomy, but this is over the line, and when the student is too ignorant to know her limitations, it's the resident's responsibility to do the right thing, and I think the fault in this case lies squarely in the intern's lap.


    Is this common where you train? If it is, do you think it's ok?
     
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  3. Winged Scapula

    Winged Scapula Cougariffic!
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    I agree with you (and responded as such in the thread referenced above).

    First of all, I trained in a program where the junior RESIDENTS didn't get enough training (myself included) in doing central lines, so while I loved teaching medical students how to do procedures, would be even more unlikely to leave them to their "own devices" as I was.

    I can understand the resident wanting the student to use the Keith needle - its a skill to have since most kits still come with it and frankly, sometimes getting a driver and a curved needle are a hassle. HOWEVER, that does not relieve him/her of the responsibility to teach the student how to properly use the Keith (as you noted in your first response, backing the needle in...at least my Chiefs did teach that to me) or if the student really was uncomfortable, put on some gloves.

    I would never leave a student or even a junior resident who was unfamiliar with central lines alone in the room. For the first several, I am gloved, gowned etc just as the student was. If they have shown some proficiency, I still have gloves, etc. available and am in the room, generally pretending to not pay attention but obviously watching what they are doing, while chitchatting with the nurse, thumbing through the chart, talking with the patient, etc. The resident/intern, whatever should NOT have left the room while a student was putting in a central line...I am presuming the student did not have enough experience to handle all the possible complications. Even if the resident stayed until it was time to sew the line in, as this post has shown, trouble can still happen - needle sticks, dropping sterile supplies on the floor, bleeding around the catheter, sticking the catheter, etc. Does the student know how to handle all of the potential complications/problems (even as mundane as not having a Op-Site or other covering available)?

    This is an example of the intern's inexperience as well - he/she probably doesn't realize all of the potential problems. I often see interns fail to teach or properly supervise medical students. IMHO, the OP's post was clear in demonstrating that his/her intern was at fault for not properly supervising the medical student and for creating an atmosphere in which the student was afraid to report the incident for fear of being punished or getting a poor evaluation.:mad:
     
  4. dynx

    dynx Yankee Imperialist
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    I think we need a little more detail. If the line was safetly in place (minus tacking it down) and the patient's safety relatively secured (not bleeding or resp problems) for the remaining minor portion of the procedure I don't think the resident walking out of the room is out of the ordinary, I've been in that situation myself. Nobody had to tell me how to not to stab myself with the needle. What I do is keep my fingers off the sharp end, I recommend this method for everyone.

    Its a straight needle. Don't stick it in your finger. This isn't rocket science.
     
  5. SLUser11

    SLUser11 CRS
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    Just because you've been in a similar situation doesn't mean it's appropriate. As smart and technically proficient of a med student as you may be, you're not qualified to do even the "remaining minor portion" of this procedure unsupervised.

    Perhaps if the resident had seen you place a couple lines already and could be sure you'd do it correctly, it would be more appropriate. However, this resident left an unexperienced student to do it without instruction.

    And, as I've already mentioned, sticking yourself is one of several complications that can occur. I'm glad that you're confident, but if you're really as smart as you think you are, you'd probably understand why this is inappropriate. Instead, from what you've given me in your post, you sound more like a cowboy.

    However, you usually have good things to say and you're funny, so I'll chalk the remark up to inexperience.
     
  6. dynx

    dynx Yankee Imperialist
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    Not to mention contaminating the needle, so clearly if you're dumb enough you can mess up even the most simple of things.

    Listen, I'm not saying that a student should be left to place a line by themselves, but at a certain point you need to be able to trust that a reasonably inteligent person can handle simple tasks like passing a needle superficially throught the skin and throwing a knot. You get into trouble, tag the line, drop something, poke yourself, you call for help. At this point in the procedure there is not much to go wrong that wouldnt go wrong with an attending leaning on your shoulder. The guy didn't turn off his pager and drive home, he stepped out of the room. I realize that as cynical as I sound I should realize people (especially medical students) are dumb enough to f*ck even this stuff up but I don't think the guy was taking that big of a leap of faith here. Interns are left daily to do things they are not qualified for with only the assurance that they can "call for help" when it's needed...whats wrong with trusting a medical student with that same experience, they will be doing it in short order anyway. Now, in hind-sight, yes, this student is clearly ******ed and apparently didn't have the common sense to immediatly seek help, she is a moron should not be left to do anything. But assuming everyone is like this is not possible.

    If this is really your idea of a cowboy then yee-haw. I think the first guy to connect two peoples arterial systems as a make shift by-pass pump was a little more ballsy than me claiming to be able to put a pin sized hole (edit: refering to the suture here not the line) in a person's neck without killing myself and the three people standing next to me. And if you could, chalk it up to the arrogance of youth, it's got a nicer ring.
     
  7. whoopsie_1

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    Yeah, but it was a female medical student.
     
  8. NDESTRUKT

    NDESTRUKT Fadeproof
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    That's horrible! Just horrible! (but funny in a way since I can see the sarcasm in it).
     
  9. whoopsie_1

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    Um. What? Oh, right, right ...sarcasm.
     
  10. dpmd

    dpmd Relaxing
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    I think there are two issues here. First is the probably a systems problem that causes residents to have so much to do that this one felt the need to step out during a procedure. Yes, it was at the end, and I do think most intelligent students would be able to complete the task without explicit instructions and someone hovering. However, the first time I sewed a line in I wasn't thinking about potential complications and I don't know how I would have responded to something going wrong (I at least had experience with using a straight needle without sticking myself from my junior high home-ec class). If they had at least been in the room, they could have prevented the student from using the contaminated needle to finish the job.

    Second is the process that has led to students agreeing to do tasks they aren't familiar or comfortable with, without asking for help. Whether it is because they don't want to get a bad eval, or if they don't realize they need help, it is a bad habit to get into. What is so wrong with creating an environment where a student (or junior resident for that matter) feels comfortable saying "hey, I don't want to screw this up. Could you walk me through it?", and the senior actually does this instead of bitching them out or taking over. I'm not saying the junior doesn't have to take some responsibilty for learning things on their own, but there is some stuff you do not learn from a book.
     
  11. Dimoak

    Dimoak Member
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    My simple question was regarding the necessity of the intern to leave the room. Was there some sort of code or episode that required the interns immediate presence and expertise? If not, could the benefit of any potential efficiency gained necessitating the intern to leave a med student unattended outweigh the possibility, however minute it may be, of something going wrong with an unattended student performing a task that he or she may not be completely comfortable with? Assuming that the student was sufficiently equipped to handle a certain task would not be a satisfactory argument to exhonorate the intern or the hospital of malpractice should the worst-case scenario occur, so why even take the risk? If protocol even so far as suggests supervision, anything short of that just may constitute negligence, accountability, and even malpractice.
     
  12. MediCane2006

    MediCane2006 Living the dream
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    I think that, as interns/residents, we have a certain obligation to judge when a student is comfortable with a procedure and when it's appropriate to offer a helping hand. The ability to do this well is one of the things that makes a good teacher, and clearly some of us have room for improvement.

    Having said that, it's definitely a fine line to walk between offering needed help and just being overbearing. I remember as a student the frustration of the resident promptly taking over a procedure if I showed the slightest bit of hesitation or uncertainty. Learning to perform a technical task properly requires a certain degree of clumsiness and struggle.

    However, I think that in the case discussed here the resident was negligent in leaving the student completely unsupervised. Sewing with a Keith needle is tricky, and if the student admitted that she was unfamiliar and uncomfortable with the technique the least the resident could have done was show her the basic movement, and watched to make sure that nothing happened. I appreciate that he/she probably just wanted to give the student some hands-on experience without someone breathing down her neck, but it's our responsibility to make sure that we still provide adequate supervision for our students. Like Kim Cox said, with a little common sense you can keep an eye on things without being overbearing.

    And yes, it probably didn't help matters that she was a girl...;)
     
  13. Frankly, I hate the Keith needle and use it only when absolutely must. I am also very surprised at how numerous indivduals do not know how to properly use this or any other needle for that matter. They then proceed to misteach their poor technique. I can tell you that I learned the "backing in" technique from SomeOne's chief. I then left her prestigious institution for two additional internships. I was shocked to find how amazing it was that an intern (me) was the only individual using the safe technique of "backing in" the Keith needle! It always seems like such a novel concept to anyone I show/teach.
    Just a couple of points:
    1. If it's not sutured in then it's NOT "safetly in place"
    2. "the patient's safety relatively secured"... Are you joking?!?!
    I could write a book on that line of crap. The physician left the patient in the hands of an UNTRAINED student with a sharp object and unsecured central access. What if the student was Hep or HIV positive ? Was the patient's safety secured now? What if the UNTRAINED student stumbled/passed out/etc... taking the line right out and resulting in a possible air embolism? Any number of things could happen.
    3. "...I don't think the resident walking out of the room is out of the ordinary..." Let's rephrase this as follows: "...I don't think the PHYSICIAN/LICENSED/TRAINED/INSURED individual walking out of the room is out of the ordinary..." Does that sound better??? Does that give you an idea of the physician patient relationship/obligation? How about the teacher student obligation?

    Some tasks may seem "minor"... and thus unimportant to... maybe you? However, it is often the little things that are overlooked and cause significant morbidity and mortality. What I see in this situation is:
    a. An untrained student robbed of their tuition
    b. An untrained student placed in danger
    c. An untrained student given the wrong message on how technical skills are taught or should we say failed to be taught
    d. A patient placed in danger
    e. A patient robbed of safety and security that they are entitled to as a patient
    f. malpractice premiums rising because of stupidity and individuals abandoning their duties as healthcare providers and teachers...

    I will let it go... a warm breeze on my cheeks... I hear the soft waves lapping the shore... the sand bewteen my toes... I shall drink another beer and let this too pass.
     
    #12 Skylizard, Apr 30, 2007
    Last edited by a moderator: Aug 30, 2008
  14. Winged Scapula

    Winged Scapula Cougariffic!
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    Now, let's not exaggerate, LS!

    I actually preferred the Keith because I had grown up sewing by hand and it was much more familiar to me than the needle driver. However, I understand that many (ahem...you BOYS) may not be as familiar with it.

    I too am suprised when I don't see others backing in the needle...seems like common sense to me. As much as I despised that particular Chief, I guess I do owe him a debt of gratitude for teaching me that technique (as an aside, funny how a little time changes things. I saw hated Chief during my Chief year when he came back to my "prestigious institution" from several hrs away to see an unusual Peds Thoracic case - and I actually found myself HUGGING him. Ughh...not sure what got over me.:laugh: )

    Your final paragraphs are excellent and should be read and reread by the users here for the clarity of thought in pointing out the obvious. The line was not "safely in place" and the student was not being properly supervised. There is a fine line between allowing a student to make mistakes and abandoning them - unfortunately, I commonly see this with interns who fail to understand the responsiblity they have - to the student, the patient and to themselves to become an outstanding teacher.

    Now enjoy the beach and have a beer for me!
     
  15. dynx

    dynx Yankee Imperialist
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    1. It's in place, safely. What it is not, is sutured in. Thats why they call it placing the line, then tying it down. Semantics is a ******ed game.
    2. What if a meteor hit? What if a wild bear rampaged through the room? Yeah, **** happens, apparently having an intern there isn't enough to prevent it happening either "what if the intern leaves? OH NOS!!!!". Maybe we should require an attending to be present for the entire thing in order to make sure the intern stays which apparently they can't be trusted to do? Or maybe we need to assume people aren't complete morons and take the hit when occasionally they turn out to be. The moral of the story here is not that the intern messed up...its that stupid ass people (students, interns and otherwise) that don't know thier limits and don't have the balls to say so are dangerous.
    3. Medical students can be both trained and should be insured, im not sure what kinda places you're working if this isnt the case, but I can see how it would influence your view on this matter.
     
  16. Dr. V

    Dr. V Senior Member
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    You're kidding right?

    Been doin central lines alone since July of my intern year, which is almost over now whoo hoo. The attendings and chiefs always know before hand however, nothing is done at our program without their knowledge (and rightfully so).

    At our program interns are EXPECTED to be able to do central lines and to learn to do them quickly as that is what is needed for getting the work done. It's just part of our job. Of course we are shadowed/TA by upper levels until the upper levels and attendings feel comfortable sending us to do them alone but it is routine for interns to place central lines.
     
  17. Bitsy3221

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    Pot....kettle.....black......???

    An excellent article posted by Dr. Cox (that cites just about every article written on the topic!):
    http://www.freewebs.com/kimberlicox/CVC.pdf
     
  18. dynx

    dynx Yankee Imperialist
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    tired...cliche...overused?

    Its a great article indeed, but not the point.
     
  19. Winged Scapula

    Winged Scapula Cougariffic!
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    There are different expectations at different programs. Some have requirements that you must document a certain number of lines before being allowed to do them alone; others require that residents always be supervised until they have reached a certain training level.

    I knew interns who had come from programs where they were allowed to do them as students; others had barely seen a line let alone put one in, so Tired's question was valid.
     
  20. Bitsy3221

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    It IS the point. The point is that although a central line placement may not the most difficult skill a resident will need to master, it is one that has the very real potential for disaster. I can offhand think of several situations where experienced, competent residents ran into trouble placing a line. The fact that it is so often dismissed as being a benign procedure magnifies the bad outcomes even more, since what happened in the OP's situation is often the setting for complications: inexperienced people are left alone with no backup should the situation go south.

    Perhaps its the years of M&M I've attended, or that I've just seen enough complications associated with lines, but I think (as with ANY procedure) that it is the cavalier attitude of relatively inexperienced people that minimize the risk of "benign" procedures/situations that combine to increase the chance of badness. I often see eye to eye with you dynx, but reading that post just reminded me of all-too-many scenes of insouciant residents who got in over their head, thought they could handle the situation and didn't ask for help until it was too late, usually followed by a good reaming by an attending.
     
  21. dynx

    dynx Yankee Imperialist
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    Okay, I'm just gonna type this out one last time then I'll let it go...I realize that many and bad complications can happen when placing a central line. Ideally, there would be a student, intern, chief, attending and 4 nurses in the room to assist. I mean, what if the student pulls out the line, falls and nocks over the intern, the chief has an MI, th attending sh*ts himself laughing and the nurses are eating a donught and can't be bothered to help? You can't build 8 levels of safety into everything, at a certain point you need to realize that there are risks and you can (and must) delegate responsibility with a slightly increase in that risk level. What that level is, is up to debate, clearly. I don't think the intern took a huge risk in this situation, I personally blame the student more for being an idiot. I think we would ALL assume that when someone sticks themselves they would know to stop suturing, obtain help with the line and go scrub the damn stick...people that watch ER regularly could probably figure that one out. Maybe I overestimate common sense.
     
  22. Dr. V

    Dr. V Senior Member
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    Yes, I realize that but it's May now so even places that you need to be "checked off" (which ours is one but I just got a bunch of lines in July and got checked off by the end of week 2 LOL) for the most part competent interns should be doing lines by now (well a long time ago actually but still).

    I just found it odd that someone was incredulous that an intern would be doing a line, but they had "done plenty" as a student at the same place. I just figgured in any place that allowed students to do lines it wouldn't be unusual for interns to be doing them. No offense meant to Tired, I just found it odd and maybe said in jest or something.

    I do also realize there are places where interns are nothing more than floor monkeys, man I would hate to be at one of those places, but I would hope those would be very few.
     
  23. supercut

    supercut Senior Member
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    At the program where I went to medical school, interns did many central lines alone, and fairly early in the year. It was common for interns to take med students through lines after, say Sept. This was another program in the southeast.

    My current program, in the northeast, is much more restricted. Partly, I think, because there is a well established PICC service, with nurses who place PICCs...thus making central lines much less common (except in the ICU) THe PICC service takes away the opportunity for interns to get experience with central lines. Since interns spend minimal time in the ICU most of the time our R2 are not comfortable with lines until they've completed the ICU rotation.

    I predict that traning nurses to put in PICCs will evenutally produce physicians who cannot place central lines.
     
  24. SLUser11

    SLUser11 CRS
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    Well, as low risk as the situation seemed, recent review of the thread showed that the patient ended up being Hep C positive. The intern will likely be OK, but faces the possibility of a lawsuit, etc.

    His behavior was irresponsible. Part of being a teacher is knowing your student's limitations, even if she does seem a little below average. I'm sure that fear and embarassment greatly contributed to her lack of common sense.

    Sweet, dude.:thumbup:

    Tired's question is legitimate. There are many programs where interns need supervision for invasive procedures, even if they could likely do them alone. Of course, you knew that, but you just wanted to show how much that is in contrast to your awesome situation.

    Rules are rules. I've done plenty of central lines, but won't be doing them unsupervised until July 1st. Also, I wouldn't assume that having supervision only occurs for "floor monkeys." I would like the way my technical skills and operative case load stacks up against most programs where the interns are free to stick patients alone starting in July.
     
  25. Dr. V

    Dr. V Senior Member
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    Dr. Hudkins out there with you was an intern here. Good guy and I know it's a good program out there.

    The "floor monkey" comment was directed toward places that never allow their interns to do anything but write notes, floor work etc. One guy I know at another place had only been to the OR 9 times when I last talked to him and that was in November so in 5 months time that's all he had seen the OR. That's the kind of place that I would consider the interns to be treated like floor monkeys.

    You are doing the lines, just not alone and as you said rules are rules. We have our rules here too, we gotta be checked off first and demonstrate satisfactory proficiency, but then we can do them without a Sr present. I just figgured that's the way most places were.
     
  26. eastcoastyall

    eastcoastyall Wisdom Onslaught
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    Wow, the autonomy so early at some places blows my mind. At my school, I only know of one medical student who has even put in a central line, and they were going into anesthesia. Guess that's the east coast mentality. That's a resident procedure for sure, mostly supervised by the fellow in the ICU as other patients get picc lines.

    To give my opinion, I don't think that we (students or residents) should be doing any procedures until we can give the indications, options, and risks, and discuss how to minimize those risks in doing the procedure. Give me a medical student who can do that about central lines and I would be floored.

    As for supervision, I can see both sides of the argument in this thread, but IMHO, in any procedure that has the potential to kill, med students shouldn't be doing that alone. Because I have certainly seen multiple patients have very bad problems.
     
  27. Winged Scapula

    Winged Scapula Cougariffic!
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    The autonomy certainly does vary.

    I never put one in as a medical student and the medical students rarely, if ever, did on surgery rotations during my residency. As noted above, PICCs are placed frequently and since we had an open SICU, even during ICU rotations you weren't guaranteed to get a line or even multiple lines as the junior surgical resident. My first month on SICU as an intern I rotated with 7 other residents so we divvied up the lines - since all Trauma, CT Surg and Vascular lines were done by that service's senior residents, there weren't many left to go around.

    I'm not defending the practice but since we got so few lines, it was necessary to have senior supervision - at the time when I was a junior resident there were no rules about who could do them and when. Trouble was, we rotated at a community hospital during 2nd year and as the ONLY resident in house, were often consulted to place central lines. No senior to help, no attending to come in (as the consults were always after hours), left to your own devices. And I was made to feel bad when I complained that I didn't have enough training and some patients paid for my inexperience (ie, a couple of PTxs, a few patients I stuck more than I should have attempting to gain access, etc.). On the other end, I'm probably better than I would have been because I had to learn on my own, but at quite a cost.

    So for those of you who are getting to place lines during medical school with adequate supervision and doing many lines as a junior resident, consider yourself lucky - there are many residents who do not get the same experience or are forced to find it without much supervision. I'm sure many of you who are so lucky feel quite confident with your skills - but you might be unaware that there are many who subscribe to the old saw that if you haven't had a complication, you haven't done enough (of said procedure).

    Still, I'm not sure the autonomy provided many of the residents in other institutions is a good thing, just as it wasn't a good thing for me. Without knowing the possible complications, what to do when they arise and of course, the potential harm to the patient makes me argue that at the junior level there is too much independence and not enough supervision and teaching. There's obviously got to be a point at which the pupil breaks free and becomes the student. MY program had it backwards - too much autonomy at junior levels and not enough at senior levels.
     
  28. This conversation can go in circles, but...
    sometimes things may seem obvious, those are the things you should recognize and NOT assume everyone knows already!!!Those assumptions cause morbidity and mortality.

    I can tell you accross the country right now there are individuals in SURGICAL training at all levels that have "accidentally" embolized a portion of a central line into the heart during a "wire change". I have seen PA catheter tips cut and sent into the heart, 3 lumen cath tips sent into the heart by SURGICAL residents and subspecialty surgical fellows. I personally observed an ICU attending pop the ETT balloon cuff while placing an IJ central line under ultrasound guidance!

    I will ask a rhetorical question of those in the surgery field...(not med-students hopefully receiving broad general training): How often have surgeons, residents or the attendings, had to treat the misadventures of line placement by PHYSICIANS of any specialty? I was once called for an emergent chest tube when a pneumothorax developed after central line placement was performed. I was surprised to say the least when I received the call at 10pm and reviewed the CXR. The "STAT" film was shot earlier that day at 7am and reviewed by the crosscover team at 10pm! I can tell you I have seen institutions that the IM residents only trained to place femoral lines and vascular injuries were not uncommon. In fact, I have recently been told that IM is rethinking if line placement procedural skills should be a required portion of the IM residents curriculum. I know of plenty of IM and FP attendings that voluntarily have surrendered their privileges for line placement because they couldn't keep up with placing 10/year in order to demonstrate competence.

    The point? Well, we are not talking about a meteor falling into the ICU when we talk about unsecure lines being dislodged or accidently pulled out by a student that by definition is not FULLY trained. Accidents happen. Supervision should happen to ensure patient protection and proper training of students. I do not assume all PGY1s are extensively experienced in central lines or any procedure for that matter. I supervise and ensure they are. As for students, I assume no student is FULLY trained. They are paying tuition so that a physician will teach them and not say, "heres the needle I want you to use, suture it in, I'm going for coffee".
    IM= Internal Medicine, FP= Family Practice

    I will close my part in this circle by repeating:
    sometimes things may seem obvious, those are the things you should recognize and NOT assume everyone knows already!!! Those assumptions cause morbidity and mortality.
     
    #27 Skylizard, May 1, 2007
    Last edited by a moderator: Aug 30, 2008
  29. Dr. V

    Dr. V Senior Member
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    I don't know about other places, but here GS residents treat our own complications plus many of the complications of the other services. We place the chest tubes for IR if they drop a lung during biopsy/tap, chest tubes for IM if a tap drops a lung etc. It's not very often that the other services even attempt a central line so if we are taking care of a CL complication it usually belongs to us (occasionally a Respiratory or CC fellow will place a line, but usually it's ours).

    The caviat is that if it is our complication we can't count the repair for credit. For example, if I drop a lung during a central line, I place the chest tube but I don't get to count it as one of my cases because they figgure you shouldn't be rewarded for screwing up (rightfully so IMO). They are also strict about checking your own CXR after a line, and checking it soon, not 10 hours later. We are pretty anal about our central lines, our weekly log in M&M has a section devoted specifically for the central lines over the past week. It's the second section, right after the "Complications" section which we start out with every week so they think they are pretty darn important.

    I went to med school here too, but I only placed 3 CL during med school, two had chest tubes already, and all three times I was walked through it with a Sr Resident who never left the room and was scrubbed, gowned and gloved, standing right over my shoulder.

    Our autonomy for central lines only comes after being "checked off" by the chief resident after they are comfortable that you are up to par. Still, if you are checked off by Chief #1, and it's the first time you have worked with Chief #2 you should't be surprised if he "drops in" during the central line even if he knows you are supposedly checked off. They will still sneak around and make sure you are capable. I don't blame them one bit, I will likely do the same thing in 4 years because lets face it, it's the Chiefs butt on the line if he lets you do something that you can't handle. Sure it's yours too, but the Chief has the ultimate responsibilty.

    Of course, nothing is done without discussing it with the Chief and Attending unless it's a life or death emergency no matter how "simple" it seems. I&D of superficial abscess, even repairing skin lacs must get approval from the Sr, then Attending before it is done. They MUST know everything. The quickest way to be fired here is to do something without your seniors or Attendings knowledge. They are very, very serious about that.
     
  30. jeffp

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    Residents with the attitude like Dynx seem to think that students are there to at least try to make resident workloads lessened to some degree. I agree with above that students pay a lot of money and deserve something of substance for it. when I was paying 50K a year in med school and got stuck with some jerk resident or intern with an attitude much like dynx, I felt cheated because (1) that person isn't making any effort to teach at all and (2) nobody at that stage in training, including myself, is such a badass that it's worth over a hundred bucks a day (do the math) just to follow him/her around. this attitude is ridiculous, and personally i think that it is a sign of weakness, that the intern/resident cannot accomplish his/her work with time and energy to spare to at least try to each one little thing for 5 minutes. pathetic, dude.
     
  31. Raidergate

    Raidergate Member
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    This is quite a stretch from what I took from his posts. Being a student sucks, period. I think we all know that. The only thing worse is being a resident, and it's tough as hell to kiss every self-entitled third year student's ass when they need it.

    Back to the original topic, pretty much the only thing that couldn't have been stopped if the intern was in the room is the needle stick itself. Everything after that would've been avoided if the resident would've seen the original stick.

    Yes, the intern should've at least observed the sewing in of the line. But, that med student is a pretty big idiot, as well. Fault lies with both parties, imo. Sucks for that girl, though. One of my attendings has hep C from a needle stick as a student, and he's still on interferon therapy. There's a lot of days he looks and feels sick as a dog.
     

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