7+ Year Member
- May 14, 2013
- Status (Visible)
- Attending Physician
From a risk management standpoint, if you're doing a thoracentesis, paracentesis or pericardiocentesis you better be prepared to write a huge check if anything goes wrong.
You're at a major tertiary care center?
You have IR/interventional cards available?
Was the patient hemodynamically unstable and unable to wait for a specialist?
So Doctor, why did you do the procedure?
Nothing you say matters, you just write the check. I think in significant hemodynamic situations/codes or with some leeway to podunk ED's situated between cows you might get some sympathy but a jury will hang you dry if you had an interventionalist upstairs sleeping while you felt badass enough to stick a needle in someone's heart and a mistake was made--even if the specialist would have made the same mistake!
For reference, with appropriate specialists precepting in residency I did
As an attending I've done only one of those, a pericardiocentesis in a code caused by massive tamponade. That, I think, is the only time we are allowed to stick a needle in a heart and if you're doing that twice per shift you're unlucky or not doing it for the right reasons.
Or just know what the tip of your needle looks like on ultrasound.