Indexing Title: MJCABAHUG’s Medical Anecdotal Report [04-3]

MAR Title: Patient for hemodialysis

Date of Medical Observation: June 2004

Narration:

  A 66 y/o male patient was referred to us for internal jugular catheter insertion.  Necessary materials as well as the consent for Internal Jugular catheter insertion were secured.

  Patient was brought to OR for the procedure.  When the catheter was inserted, aspiration was done, air not blood was aspirated, and so the catheter was pulled out.

  The procedure was repeated, still air was aspirated and at this time patient complained of difficulty of breathing, and body weakness.  My senior resident asked a clerk to get the vital signs, the BP she said was 90/60, my senior resident again asked the clerk to check the lungs , she said decreased breath sound on the right.  We were alarmed. I double checked the breath sound, to me there was equal breath sounds.  But anyway, we prepared thoracostomy tube F36 and a thoracostomy bottle.  Chest x-ray was done which revealed normal lungs, no pneumothorax.  Heart slightly deviated to the left. 

  Later on patient calmed down and was breathing normally.  Internal Jugular catheter insertion was again repeated and was successfully inserted, taking into consideration the position of the heart.

Insights (Discovery, Stimulus, REINFORCEMENT):

1. No matter how many procedures you have done, you should always remember each patient is unique and that you should be prepared for anything that will happen.

2. complications/ outcome of the procedure should be properly explained

3. consent should include the possibility of thoracostomy.