Respectful Insolence

D’oh! I hate it when that happens!

Fortunately, I’ve never had this happen when I’ve placed a central venous catheter:

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See that bright line with the “J” at the end of it? That’s the guidewire over which a central venous catheter is threaded. It’s a very bad thing when you push it in so far that you lose it. Worse, is not reporting or admitting that you lost it before transferring a patient to another hospital. (You’d have to be really, really stupid not to realize that you lost it.)

Comments

  1. #1 Jared
    December 4, 2007

    I dunno, after taking my first NBME shelf exam, I feel about that stupid. Please tell me that the exams are simply hell and must be endured.

  2. #2 Dr Aust
    December 4, 2007

    I thought catheters were all marked every so-many cm so that you could keep track of how much length you’d threaded in?

    The past-the-use-by-date ones Mrs Dr Aust used to snarf for me to show the (pre-clinical year) students were, anyway.

    Of course, I guess that wouldn’t help if you went the right distance but the wrong direction

  3. #3 lights n steel
    December 4, 2007

    we’ve had a few of these. Not that *we* did, but that got sent to us from other hospitals. We were able to remove them with endovascular techiniques, therefore avoiding a huge operation. Hopefully everything went well for this guy.

  4. #4 Jim
    December 4, 2007

    I can imagine how this happened – I’ve seen “cowboy” docs advance the catheter over the guide wire in the firm faith that the end of the wire will magically appear at the hub of the catheter.

    Me, I was too well-indoctrinated (i.e. repeatedly beaten by my attendings) to do that. Besides, one of the first time I watched someone put in a central line (in medical school), they did exactly that – lost the wire. In that case, however, the tip of the wire ended up coiled in the R ventricle.

    It’s always best to learn from the mistakes of other people, if you can!

    Jim

  5. #5 daedalus2u
    December 4, 2007

    I don’t know much about this kind of stuff, but if it is like threading a needle or pulling electrical wire, sometimes it is easier if there is already something in there that you can hook onto. Like sometimes electricians leave something in place in case they need to pull more wire through a conduit.

  6. #6 DLC
    December 4, 2007

    Um… oops. At least it wasn’t something big like a scissors or a retractor.

  7. #7 Rjaye
    December 4, 2007

    Holy crud!! I’d be terrified to move if that happened to me.

    The doc was probably just hitting his head against a wall after that, and hopefully was later punished for not paying attention in class.

  8. #8 Andrew Dodds
    December 5, 2007

    Faced with this, you should simply choose from the following -

    (a) Do no follow up examns or checks, so you never see the problem in the first place,

    OR

    (b) Tell the patient that the catheter has moved itself (using it’s crystalline quantum structure) to the optimal position for the patient’s energy flow,

    OR

    (c) Blame the patient for having negative thoughts about the procedure and therefore making it fail,

    AND

    (d) Book the patient in for 10 more sessions of ‘catheter realignment’ at their own expense.

    It’s only when you are troubled by this strange thing called ‘Ethics’ that this is a problem.

  9. #9 Dianne
    December 5, 2007

    Everyone realizes, I hope, that the big error was not letting the guidewire get lost–it’s bad, but sh!t happens from time to time. The big error was not admitting it so that it could be dealt with in a proper and timely manner. If you aren’t able to face up to your mistakes, get a job where your mistakes won’t kill people.