Friday, July 11, 2008
Wednesday, February 20, 2008
STUCK TLC
EVENT: Patient was a 27 year old female, who had undergone MVR (Mitral Valve Replacement), for severe MS and MR. On her third post-op day, nearly afternoon 3 pm, she was ready to be shifted out of ICU and was decided by the ICU team to get rid of all her lines, including arterial(removed earlier in the day), foley's, and TLC. The TLC on removal of sutures was not budging from its location. On slight traction it was found to move in and out (up and down) with heart beats.
The whole ICU team, including the senior intensivist on duty, gave a try which was futile. The team was helpless.
The possibility was during the later part of her open heart surgery, while they were switching circulations from CPB (cardio-pulmonary bypass) to normal, the TLC (which was inserted during anesthesia) would have have inadvertently got stuck in the sutures while closing the great vessels.
Not sure as to what to do we informed the senior CTVS surgeon to check on her and also the cardiologist on duty. The options left were either to remove it under fluroscopic guidance in cath lab or re-open her chest and release the sutures entangling the TLC with the great vessels or use additional force and risk internal post-op bleeding, the chances of which are quite large..
SOLUTION: The surgeon on evaluation decided to use additional force and pull it out and take her to OR, if any complications. The main idea was to avoid unnecessary re-exploration and its associated complications. Once the OR was ready on applying gentle and constant traction the TLC came out with ease. A repeat x-ray of chest and monitoring her overnight did not reveal any hemodynamic instability. Fortunately, the patient did not have to experience the trauma of reexploration and its complications.
Though this issue was resolved in a very easy manner a STUCK TLC is a night marish experience for both the intensivist and the patient.
In a ICU TLC can be stuck for a good number of reasons including an infection at insertion site or internal infection. Though it is not a common occurence care has to be taken when handling such a situation.
If any of you have experienced similar events, please feel free to write back with a detailed description of event.
The whole ICU team, including the senior intensivist on duty, gave a try which was futile. The team was helpless.
The possibility was during the later part of her open heart surgery, while they were switching circulations from CPB (cardio-pulmonary bypass) to normal, the TLC (which was inserted during anesthesia) would have have inadvertently got stuck in the sutures while closing the great vessels.
Not sure as to what to do we informed the senior CTVS surgeon to check on her and also the cardiologist on duty. The options left were either to remove it under fluroscopic guidance in cath lab or re-open her chest and release the sutures entangling the TLC with the great vessels or use additional force and risk internal post-op bleeding, the chances of which are quite large..
SOLUTION: The surgeon on evaluation decided to use additional force and pull it out and take her to OR, if any complications. The main idea was to avoid unnecessary re-exploration and its associated complications. Once the OR was ready on applying gentle and constant traction the TLC came out with ease. A repeat x-ray of chest and monitoring her overnight did not reveal any hemodynamic instability. Fortunately, the patient did not have to experience the trauma of reexploration and its complications.
Though this issue was resolved in a very easy manner a STUCK TLC is a night marish experience for both the intensivist and the patient.
In a ICU TLC can be stuck for a good number of reasons including an infection at insertion site or internal infection. Though it is not a common occurence care has to be taken when handling such a situation.
If any of you have experienced similar events, please feel free to write back with a detailed description of event.
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