Indexing Title:
HTURINGAN’s Medical Anecdotal Report [05-06]

MAR Title:  A First Year Folly

Date of Medical Observation: July 2006

Narration:

During one of the peripheral rounds ( ward referrals from different services/department),  we were halted from our rounds by a referral in Medicine ward.  It turned out that a first year GS resident was called in to do central line access for CVP to a patient diagnosed with leptospirosis, however she apparently mistook the brachial artery for the vein and instead of confirming if it was indeed the vein proceeded in nicking the artery to put her CVP line.  She didn’t expect the bullet like trajection of arterial blood.  We were called in to repair the poor artery.  The arm of the patient was drowning with his own blood.  I did proximal and distal control with a bulldog did embolectomy and proceeded repairng the artery with prolene suture.

Insights (PHYSICAL, psychosocial, ethical) ,Discovery, Stimulus, REINFORCEMENT:

It is easy to mistake the artery for a vein especially for dehydrated patients with collapsed vessels.  And signs to check the difference sometimes are not present, like pulsation, the color, the size, even the location may be anomalous.  An easy way to confirm this is to use a small hypodermic needle and puncture the vessel if it does not spurt and blood that comes out is dark red, then you’ve hit your target, but if it spurts obviously you got the wrong vessel.  All one has to do is apply digital pressure and in 30 seconds or less this will stop.  If you fail to recognize the artery and incise it you are committed to do primary repair.