I've been taking care of several patients during my stint in the ICU. Most come and go over the course of a day or two, as we manage their pressing issues and move them out. A few, however, just seem to linger. Never quite getting better, never really getting worse, just sort of fixtures in the ICU scenery. One such individual, I shall name him Mr. A, had in been in the unit almost the entire time I was there. Never really making any progress, Mr. A just sort of hung around like a bump on a log. Or rather, more like the log itself, for Mr. A weighed nearly 400 pounds.
Though he was often ornery and nearly impossible to understand (which, I suppose is reasonable seeing as how he had a endotrachial tube down his throat), he had grown on me and I was hoping he'd be able to rebound from all of his complications and make a full recovery.
My last day in the unit, one of the nurses inadvertently pulled the femoral art line which had been helping us monitor Mr. A's tenuous hemodynamic status. The line needed to be replaced, and, as the intern and official scut monkey, the responsibility fell to me. My first inclination was to try to replace the old line for a new one over a wire, but my fellow didn't want me to put the line back in his femoral artery, because lines near the groin are more prone to infection (for reasons obvious to everybody). On top of that, Mr. A had significant abdominal pannus* which was going to make any type of femoral line insertion an arduous task.
So I went for a radial art line instead. Unfortunately, in addition to having rather hefty arms, he had become quite edematous during his ICU stay. End result: his pulse was near impossible to find. I spent 40 minutes trying to find his artery with my needle before giving up and having my fellow take a stab at it (literally). She too failed. We even brought in a pencil doppler from the OR downstairs to help us locate the artery, to no avail. Having made swiss cheese of his right wrist, we focused our efforts on his left. One hour later, we had a pin cushion for a patient, but no arterial line.
Finally, my frustrated fellow threw in the towel and told me to go ahead and do the femoral. As if that was going to be any easier. I grabbed the nurse and together we used about half a roll of silk tape to bolster poor Mr. A's belly up. However, even that didn't quite give me the exposure I needed. I had to then call in reinforcements. I had another intern and a poor rotating med student yanking away on this guy's belly, while I struggled to find his femoral pulse. There was so much redundant tissue to wade through that if my pannus retractors slackened their grip, I would literally lose sight of my hand. With my patience wearing incredibly thin, I went for the artery with my finder needle.
Unsuccessfully.
Sadly, this needle was just not quite long enough to make it through all the adipose tissue between me and the artery. We had to get an 18 gauge spinal needle to get the length we needed. Three hours after the ordeal began, I finally drew back bright red, pulsatile blood into my syringe. The med student, the other intern, and the nurse, who had all been hard at work retracting pannus under the sterile field, let out a huge sigh of relief. I quickly finished up the job and sewed the catheter in before anything else could go wrong.
And thus concludes my ICU adventure. A grueling, yet highly educational experience which will serve as the foundation of my entire intern year. How apropos that my last day in the unit should have been as ridiculous as it was.
My intern year is now 1/13th over. Next stop: Dermatology.
_________________
*Pannus has become Cami's favorite "medical word." This term cannot be utilized in any converstion or in any setting without her giggling about how a word like this even exists. I am glad she takes such supreme pleasure from hearing it said, though I doubt she would find it so funny if I had one myself.
Though he was often ornery and nearly impossible to understand (which, I suppose is reasonable seeing as how he had a endotrachial tube down his throat), he had grown on me and I was hoping he'd be able to rebound from all of his complications and make a full recovery.
My last day in the unit, one of the nurses inadvertently pulled the femoral art line which had been helping us monitor Mr. A's tenuous hemodynamic status. The line needed to be replaced, and, as the intern and official scut monkey, the responsibility fell to me. My first inclination was to try to replace the old line for a new one over a wire, but my fellow didn't want me to put the line back in his femoral artery, because lines near the groin are more prone to infection (for reasons obvious to everybody). On top of that, Mr. A had significant abdominal pannus* which was going to make any type of femoral line insertion an arduous task.
So I went for a radial art line instead. Unfortunately, in addition to having rather hefty arms, he had become quite edematous during his ICU stay. End result: his pulse was near impossible to find. I spent 40 minutes trying to find his artery with my needle before giving up and having my fellow take a stab at it (literally). She too failed. We even brought in a pencil doppler from the OR downstairs to help us locate the artery, to no avail. Having made swiss cheese of his right wrist, we focused our efforts on his left. One hour later, we had a pin cushion for a patient, but no arterial line.
Finally, my frustrated fellow threw in the towel and told me to go ahead and do the femoral. As if that was going to be any easier. I grabbed the nurse and together we used about half a roll of silk tape to bolster poor Mr. A's belly up. However, even that didn't quite give me the exposure I needed. I had to then call in reinforcements. I had another intern and a poor rotating med student yanking away on this guy's belly, while I struggled to find his femoral pulse. There was so much redundant tissue to wade through that if my pannus retractors slackened their grip, I would literally lose sight of my hand. With my patience wearing incredibly thin, I went for the artery with my finder needle.
Unsuccessfully.
Sadly, this needle was just not quite long enough to make it through all the adipose tissue between me and the artery. We had to get an 18 gauge spinal needle to get the length we needed. Three hours after the ordeal began, I finally drew back bright red, pulsatile blood into my syringe. The med student, the other intern, and the nurse, who had all been hard at work retracting pannus under the sterile field, let out a huge sigh of relief. I quickly finished up the job and sewed the catheter in before anything else could go wrong.
And thus concludes my ICU adventure. A grueling, yet highly educational experience which will serve as the foundation of my entire intern year. How apropos that my last day in the unit should have been as ridiculous as it was.
My intern year is now 1/13th over. Next stop: Dermatology.
_________________
*Pannus has become Cami's favorite "medical word." This term cannot be utilized in any converstion or in any setting without her giggling about how a word like this even exists. I am glad she takes such supreme pleasure from hearing it said, though I doubt she would find it so funny if I had one myself.
