Monday shift, call from Internal Medicine: A patient needs a deep venipuncture for fluids.
Despite reluctance, Dr. Li, who was on duty, went to the internal medicine department.
Why reluctance, mainly because this puncture itself is not a unique skill of the anesthesiology department. Like intensivists or emergency physicians, they should all know this technique. However, the hospital imposed this work on the anesthesiology department.
This adds to the workload for the busy anesthesiology department.
Although I have ideas in my heart, I have to work hard. After arriving in the internal medicine department, he started various tasks of puncture.
After reviewing the medical records, he frowned at the patient’s serious condition. The most recent chest scan showed that the patient’s left thoracic cavity was filled with tumor tissue. This means that there is absolutely no problem with the right thoracic cavity.
Considering this, Dr. Li chose the right internal jugular vein for puncture. Compared with the subclavian approach, the probability of pneumothorax in this position is very low.
When everything was ready, he started piercing.
However, one of the patient’s indicators was abnormal, and he broke out in a cold sweat: the central venous catheter that had just been indwelled was blocked.
First reaction: Will the catheter run out of the blood vessel? Because the blood cannot be drawn back when it runs out of the blood vessel.
However, years of puncturing experience convinced him that the catheter was inside the blood vessel. Because the guide wire is smooth and not discounted, it is almost impossible for this to be a sign of running out of the vessel.
In a few seconds, Dr. Li’s brain was running at high speed, and he rethought all the possibilities he could think of. However, there are few clear aspects to be found.
At an accidental glance, he suddenly noticed that there was something unusual about the syringe he had just used to draw blood. He picked it up and saw that the blood in the syringe had been clotted.
Seeing this, he immediately understood why. So, he changed to a 20ml syringe and pulled the central venous catheter with force. As expected, a slender thrombus was pulled out.
It stands to reason that Dr. Li’s movements are very fast, and there is almost no time for the blood to coagulate, so why is it coagulated? Apparently, the patient had a problem with blood clotting.
However, preoperative clotting is not out of the ordinary. In each assay, the clotting time was only a little shorter.
At this time, he remembered a knowledge point: the blood of tumor patients is mostly in a hypercoagulable state. At the time, I thought this was a point of knowledge. I didn’t find it, but this time I found it.
Back in Corey, he dug into this knowledge again. Due to this hypercoagulable state, the incidence of lower extremity deep vein thrombosis and pulmonary embolism is much higher than that of normal people if it is a bedridden tumor patient.
After completing the knowledge, he immediately called the internal medicine department and told the doctors in their department to prevent thrombosis for the patient.
Here is a reminder: This kind of change in cancer patients must be paid attention to. In the perioperative period, it is very likely that this little change will lead to serious complications.
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~