Doctor of Healing

Chapter 326 Knotting
Icu Director Qian pushed open the door nervously and reported the situation.

"Director Bai, the patient has a problem."

"Say." Director Bai said one word concisely.

"Just now the patient developed refractory hypotension, and the booster drug given has no effect, and he is rehydrating."

"What about drainage?"

"The drainage was fine, I gave norepinephrine."

Director Bai got up, put on a sterile cap and mask, and went to the ICU with Director Qian.

Under the action of norepinephrine, the patient's blood pressure began to rise. Director Bai did not blame Director Qian, and stood at the head of the bed with his hands behind his back to watch carefully.

The situation was not as stable as before. The patient's blood pressure did come back under the action of norepinephrine, but it did not stop at the normal value or a slightly higher normal value.

血压像是过山车一样，高压从70毫米汞柱升到80，再到90、100、130、150，最后定格在183毫米汞柱附近。

"There is something wrong with the waveform of the Swan-Ganz catheter."

The directors of the Circulatory Medicine Department and the Cardiac Surgery Department both noticed this, and they both reminded in unison.

Director Qian saw that Director Bai was silent, so he started to get busy on his own.

After stopping the norepinephrine first, Director Qian discussed with Director Zhang of the Cardiac Surgery Department and the Director of the Circulatory Medicine Department for a few minutes, and reported to Director Bai, "Director Bai, the Swan-Ganz catheter may have failed, and it is recommended to take it out."

"Take it." Director Bai stepped aside and did not interfere with the clinical work.

Director Zhang of the Department of Cardiac Surgery first inserted the right subclavian vein catheter and tried to remove the Swan-Ganz catheter.

But seeing that the last paragraph was about to be pulled out, Director Zhang felt slight resistance.That kind of force is so small that it seems that the catheter can be taken out with a little force.

But he was careful not to force the Swan-Ganz catheter out.

The most taboo of all kinds of operations and postoperative patients is to use brute force, because people's hearts are separated by the belly, and no one knows what happened inside.

Director Zhang asked someone to push the bedside X-ray machine to see what happened to the Swan-Ganz catheter.

Swan-Ganz balloon floating catheter is a tool for measuring pulmonary arterial pressure and pulmonary capillary wedge pressure, which is necessary for cardiac surgery.

During the operation, the measurement work was carried out after it was inserted, but the waveform displayed by the floating catheter was not correct. No matter how you looked at it, it seemed that there was a problem with the Swan-Ganz catheter.

After filming, a doctor in the ICU took the film box to the radiology department to develop the film.

Ten minutes later, Director Bai and others saw the video on the computer.

The moment they saw the image, everyone was inexplicably astonished.

The Swan-Ganz catheter has a knot at the head...like the first knot in a shoelace.

Really special!

Director Bai cursed in his heart.

What's the matter!How could such a weird thing happen to a perfectly good heart transplant operation!
Knotted, the Swan-Ganz catheter enters from the internal jugular vein, through the superior vena cava to the right atrium, right ventricle, and pulmonary artery.

Somehow, the Swan-Ganz catheter got a knot during the removal process.The floating catheter, which could have been taken out easily, could not be taken out because of a knot.

The knot was not killed, because Director Zhang was very careful and did not use brute force in the end.But what if he was not killed?The shape has been formed, and any method is useless.

After seeing the film, all the experts present were silent.

The incident happened suddenly, and everyone present was a little confused.The operation went well, but the problem actually appeared after the operation, in a knot.

Swan-Ganz Catheter Knotted, What's Next?
With a newly transplanted heart, no one expected such a troublesome thing to happen.

The experts in the expert group wanted to scold people, especially Director Zhang of the Department of Cardiology, his face turned red.

The Swan-Ganz catheter is expensive and not used by many patients, but it is often used in cardiac surgery.Director Zhang has seen many patients with Swan-Ganz catheters, but he has never seen any knots.

Cursing won't solve the problem, the problem is what to do next.

Several experts in cardiology, circulation, and critical illness fell silent, and even Lu Gang, who had one eye above the top, did not speak.

No one has seen this before, and they don't know how to deal with it.

Director Bai started to make phone calls, calling the relevant directors and experts from the Vascular Department and other departments for consultation.

Come with them, and Dean Zhao Jixiang.

First understand the condition, and then remove the subclavian vein catheter under the guidance of the director of the B-ultrasound room with two-dimensional color Doppler ultrasound.

Up to this point, the patient's vital signs were stable and there were no other complications.

Then there is how to take out the Swan-Ganz catheter.

"Can the vascular department cut the jugular vein?" Director Bai asked.

"It's hard." Director Wang of the Vascular Department said without hesitation, "If you pull it out again, the knotted part will be tighter, and the diameter will be very thick. It is difficult to ensure that nothing will be touched when passing through the jugular vein."

What he said was relatively general, but those present knew it.

There are dense blood vessels and nerves in the neck. If such a thick node walks in the jugular vein, it should not be too easy to encounter some nerve sensor and cause sudden cardiac arrest.

"Dean Zhao, what do you think?" Director Bai asked with a frown.

"Listen to the opinions of the experts." Director Zhao began to practice Tai Chi.

He himself came out of the clinic, but as an orthopedic surgeon, it is not very possible for Zhao Jixiang to give constructive advice when it comes to heart transplantation.

Director Bai was only out of respect, and went through the process to ask Dean Zhao for his opinion.

"What about Zhao Xiangming, why hasn't he come yet!" Director Bai asked with a frown.

"On the weekend, Director Zhao should go fishing." ICU Director Qian knew Zhao Xiangming's habits and hobbies, and said helplessly, "And Director Bai, I'm not going to put it nicely, it's useless for Zhao Xiangming to come."

"Always give it a try."

The knotted position of the Swan-Ganz catheter is in the blood vessel, and the interventional department has enough weight involved in this kind of operation.

After more than half an hour, Zhao Xiangming rushed over panting.

"Dean Zhao, Director Bai, I'm sorry, the fishing place is a bit far today." After Zhao Xiangming came, he apologized first.

"Look at the situation, do you think it can be taken out?" Director Bai didn't curse, but asked directly.

Zhao Xiangming looked at the video data and shook his head like a rattle.

"Impossible, absolutely impossible." Zhao Xiangming said, "Although the position is relatively shallow, if you want to untie the button here, you need to use a guide wire to push the head of the Swan-Ganz catheter out."

"There is a blood flow effect, and the point-to-point solution to the problem is basically impossible."

Zhao Xiangming spoke very simply and resolutely.

"Ugh."

I don't know who sighed deeply.

Swan-Ganz floating catheter knotted in the body, such absurd thing has never been heard!But it is such a rare situation, and it is definitely not possible to use interventional surgery. What should I do next?
"Really?" Director Bai stared at Zhao Xiangming.

"..." Zhao Xiangming concluded, he hesitated, "Director Bai, let me make a call."

(End of this chapter)