Tech Wars - anesthesia tech stories

[gtb]

---

Members don't see this ad.

A thread for tech horror stories ;-) Hopefully other

Checked the bronchoscope, not much battery life and super dim light, called the tech for a new battery, he turned it on, saw the dim light, told me it was, "good enough." Went to the tech room myself to get a battery, and was told by the tech lead that, "residents are not allowed to replace batteries in the FOB because they are too wasteful." W...T...F? They belong to a union, so no hope of changing things here.

 

[leaverus]

Weird. Where i trained the techs were great - always helpful, courteous, and nice people you could shoot the breeze with. Maybe you need to butter them up some more? Not insinuating anything, but do you treat them as underlings? Otherwise, a tech saying the brightness on the FOB is "good enough" is totally unacceptable and simply not his call.

 

[Bertelman]

At the main hospital, the techs are great- always willing to get anything you need. No lip.

When I did a month at the outpt clinic, there was a moment when we wanted to use a FOB to assist with a nasal intubation. Was it absolutely necessary? No. Was it a clinically useful educational opportunity? Absolutely. I went to the workroom, spotted two scopes on the wall, and asked the tech for a scope for the next case. This was around 1500. A few minutes later, he came back to the room to confirm that this was absolutely needed for this case, and I wasn't just using it to play around. Went on about how there is only two scopes, and we need to save them for emergencies.

I persisted, asked him to please leave the scope in the room. Our plan changed, we ended up not using it, but the moral of the story is this: You're the MD/DO and you should get what you need, as long as it is reasonable. Be polite (unless they put up a big wall), and try to work with them. In my scenario, I would have found it pretty unlikely that an ASC would have found itself in the midst of 2 difficult airways after 3 p.m., so I persisted. I understood his reasoning, but ultimately I believed I wasn't putting anyone in harm, and it would benefit my education.

In your scenario, I would have enlisted your attending to go in there and shake things down. Otherwise, try the passive-aggressive way and just leave the light on for the duration of the case. They'll have to change the battery.

 

[bigeyedfish]

True story. I am withholding names to protect the innocent and not so innocent.

No techs are allowed to change out soda lime at my institution. That is the residents job. I thought this was total crap, but a lot of things are like that here so I wasn't surprised. The soda lime stems from an incident 10 or so years ago. The story I got was, regular case, healthy patient. Induction, tubed easy, no EtCO2 and no breath sounds. The bag was very tight. No air was moving. They reconfirmed tube placement visually, then said "holy shiznit we've got a pneumo." Or words to that effect. Patient got a chest tube. But the situation does not improve. No breath sounds, no air movement. "we've got bilateral pneumos!" Patient gets a CT on the other side. Nothing. Finally someone gets the idea that the machine might be be the problem and they ventilate the patient with an ambu easily.

The tech had replaced the co2 canister without taking it out of the plastic.

Of course, like someone else said, they're union and can't be fired. She's still here. Whenever she gives me crap I just say "show me how to change out this soda lime" and she covers her ears and leaves.

 

[bigeyedfish]

I could go on like this all day.

Prior to induction, I called a tech for a different size LMA. Rather than take the time to put on a mask she opened the door to the OR, yelled my name, and threw the lma from 10 feet away onto the awake patients belly. That was pretty impressive actually.

 

[Gern Blansten]

True story. I am withholding names to protect the innocent and not so innocent.

No techs are allowed to change out soda lime at my institution. That is the residents job. I thought this was total crap, but a lot of things are like that here so I wasn't surprised. The soda lime stems from an incident 10 or so years ago. The story I got was, regular case, healthy patient. Induction, tubed easy, no EtCO2 and no breath sounds. The bag was very tight. No air was moving. They reconfirmed tube placement visually, then said "holy shiznit we've got a pneumo." Or words to that effect. Patient got a chest tube. But the situation does not improve. No breath sounds, no air movement. "we've got bilateral pneumos!" Patient gets a CT on the other side. Nothing. Finally someone gets the idea that the machine might be be the problem and they ventilate the patient with an ambu easily.

The tech had replaced the co2 canister without taking it out of the plastic.

Of course, like someone else said, they're union and can't be fired. She's still here. Whenever she gives me crap I just say "show me how to change out this soda lime" and she covers her ears and leaves.

A colleague at another institution had this happen. Luckily, the problem was discovered prior to going as far as in your case. I guess that tech is the reason that the plastic is clearly marked "remove before use" now. Considering how fraught with potential problems the soda lime change out can be, it is probably best that the residents do it. Every time I think I have seen it all, I discover that someone has found a totally new way to screw up the soda lime change. It seems so simple.

 

[gtb]

In your scenario, I would have enlisted your attending to go in there and shake things down. Otherwise, try the passive-aggressive way and just leave the light on for the duration of the case. They'll have to change the battery.

Not worth the hassle trying to force a change. They keep the batteries locked up, and not available to anyone except the techs, not even the attendings. I'll just buy a few batteries and keep them around. Low expectations help keep me sane.

 

[Gern Blansten]

Not worth the hassle trying to force a change. They keep the batteries locked up, and not available to anyone except the techs, not even the attendings. I'll just buy a few batteries and keep them around. Low expectations help keep me sane.

Don't ever buy a McGrath scope. I think those batteries need changing after each use. Your techs would go ballistic. Pretty short sighted of your department to be such battery nazis. They are, after all, just batteries.

 

[IlDestriero]

Not worth the hassle trying to force a change. They keep the batteries locked up, and not available to anyone except the techs, not even the attendings. I'll just buy a few batteries and keep them around. Low expectations help keep me sane.

You know, if you add up all the savings on those 1/2 dead batteries you can probably pay the salary of an anesthesia tech.
When I read these threads about poor misguided leadership it makes me sad.
Your attendings have to be a bunch of weenies to put up with that level of BS. The brightness of the light is a patient safety concern. If you say it's not bright enough it's not. Cost cut patient safety items at your own peril.👎

 

[pgg]

True story. I am withholding names to protect the innocent and not so innocent.

No techs are allowed to change out soda lime at my institution. That is the residents job. I thought this was total crap, but a lot of things are like that here so I wasn't surprised. The soda lime stems from an incident 10 or so years ago. The story I got was, regular case, healthy patient. Induction, tubed easy, no EtCO2 and no breath sounds. The bag was very tight. No air was moving. They reconfirmed tube placement visually, then said "holy shiznit we've got a pneumo." Or words to that effect. Patient got a chest tube. But the situation does not improve. No breath sounds, no air movement. "we've got bilateral pneumos!" Patient gets a CT on the other side. Nothing. Finally someone gets the idea that the machine might be be the problem and they ventilate the patient with an ambu easily.

The tech had replaced the co2 canister without taking it out of the plastic.

So what you're saying is that a patient got two unnecessary chest tubes because the anesthesiologist skipped doing a machine check?

 

[IlDestriero]

So what you're saying is that a patient got two unnecessary chest tubes because the anesthesiologist skipped doing a machine check?

Yeah, it's easy to blame the tech for that, but the fault lies with the anesthesia resident and therefore the attending. You should do a machine check immediately prior to starting. Before I asked the surgeons to place 2 chest tubes for unexpected bilateral pneumos, I think/hope I would have taken another 30 seconds to consider other, more likely, diagnoses. What about profound bronchospasm with no air exchange? I've been there. If you are squeezing the hell out of the bag (say PIP 50?) you will have a leak unless there is a mechanical blockage in the system. No leak = no output from the vent, not bilateral pneumo. The tech F 'ed up, but the anesthesiologist was the one that was at fault, twice apparently. (failure to properly check the machine before starting the case and the questionable DDx).

 

[Bertelman]

So what you're saying is that a patient got two unnecessary chest tubes because the anesthesiologist skipped doing a machine check?

Exactly. And by not understanding what can go wrong with the gas machine.

 

[bigeyedfish]

So what you're saying is that a patient got two unnecessary chest tubes because the anesthesiologist skipped doing a machine check?

It was a failure on many levels