Procedural Complications: Any to add?

[emergiQ]

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I'm making a list of procedural complications that occur in the practice of emergency medicine that can be verified radiologically. Anyone got any additions? This is my list so far:

Intubation: Mainstem, depth problem, Perforation?, stent complication eg. dislodgement?, Esophageal placement, Teeth visible after trauma post direct LG

Tracheostomy: Misplaced/false passage
NG tube: In airway, coiled

Central line: Pneumothorax, Hemothorax, Arterially placed, Misguided (i.e. going up the EJ on a subclav, going straight across, etc.), broken catheter, floated guidewire

Pacemaker: broken leads, perforation

Chest tubes: kinked, subcutaneous, subdiaphragmatic, wrong area of lung...

 

[Apollyon]

NG tube: In airway, coiled

Chest tubes: kinked, subcutaneous, subdiaphragmatic, wrong area of lung...

NG tube: - intracranial

Chest tubes: - intraparenchymal

 

[emergiQ]

NG tube: - intracranial

Chest tubes: - intraparenchymal

Should I look through some of your old charts circa 2004 ? (just kidding! Folks, he was flawless. flawLESS!)

How's tricks in SC? PM me...

 

[DocZ]

Chest tubes: Intra-ventricular, Intra-hepatic (seen both)

 

[kungfufishing]

intra ventricular? wow. trochar or what?

 

[DocZ]

If memory serves, it was a pigtail catheter + overzealous surgical resident. Wasn't there when it was placed but saw the aftermath.

 

[crewmaster1]

Disclaimer: these are not my complications, just potentials or ones I have heard of.

Needle stick to person doing it!

Chest tubes: intragastric, kinked tube, intercostal arterial laceration, nerve damage

Central lines: intra-arterial with subsequent ischemic stroke, fem line bladder stick or bowel stick (especially at risk if patient with hernia)--never good to aspirate stool.

 

[debvz]

Disclaimer: these are not my complications, just potentials or ones I have heard of.

Needle stick to person doing it!

Chest tubes: intragastric, kinked tube, intercostal arterial laceration, nerve damage

Central lines: intra-arterial with subsequent ischemic stroke, fem line bladder stick or bowel stick (especially at risk if patient with hernia)--never good to aspirate stool.

Two of the worst I've seen:

Chest tube (by ED) through the lung and lacerating the pulmonary vein (died in surgery attempting repair)

Central line placed intra-arterial (by Anesth) and removed, bleeding into pericardium and causing tamponade (had to add sternotomy to that ex-lap)

Sort of makes you think twice before you let your med student do that "easy" tube or line...

 

[deleted77919]

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[emergiQ]

Saw this on my rads rotation . . .Chest tube, on X-ray AP tube is crossing the midline. On CT tube is intraparenchymal and intramediastinal. Fortunately managed to avoid anything important in the mediastinum.

Intramediastinally, contralaterally? 😱

 

[SoCuteMD]

Two of the worst I've seen:

Chest tube (by ED) through the lung and lacerating the pulmonary vein (died in surgery attempting repair)

Central line placed intra-arterial (by Anesth) and removed, bleeding into pericardium and causing tamponade (had to add sternotomy to that ex-lap)

Sort of makes you think twice before you let your med student do that "easy" tube or line...

Sorry, but this attitude is crappy and has no basis. Med students need to place that first tube/line at SOME point - be it now or in residency.

 

[deleted77919]

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[Hallm_7]

Foley catheters curling around inside the urethra because it can't pass through the prostate. Not lifethreatening like so many on here that were mentiond, but I can't imagine many things being more painful.

 

[Arcan57]

Left subclavian triple lumen attempt that ended up in the LIMA, vessel rupture while attempting to wedge Swan-Ganz catheter, intrasplenic chest tube, hemorrhagic shock after excising thrombosed hemorrhoid, methemoglobinemia after NG placement, septic joint after arthrocentesis, and ever course the ever popular post-LP headache.

 

[DrQuinn]

Chest tube to pulmonary artery. Obviously had gigantic amounts of output, so they thought it needed an immediate thoracotomy. Oopsie!

Central line (SC) intrapleurally, i.e. all the Parkland forumla turned into a tensiono-thorax!

Q

 

[deleted109597]

1. Infection
2. Damage to underlying tissues/structures
3. Disability
4. Death

Universal for every procedure. From IVs to craniotomies.