Hypothetically, ECMO vs intralipid...

[woopedazz]

Hypothetically, let's say you're in a Cath Lab and local anaesthetic was mistaken for contrast and injected directly into the coronaries. The patient immediately arrests. Thoughts on intralipid directly into the coronaries while awaiting ECMO/retrieval?

It sounds like a really dumb idea... But I just can't shake the thought

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[Dr.Jekyll75]

i wouldn't do it directly in the coronaries ... if theres not much room for blood and they need a stent, i doubt it be enough room for lipids... sounds like a rough case. Eventually it will get to the heart but direct injection idk

 

[Bertelman]

“Hypothetically”

 

[PpfSuxTube]

Definitely not direct to coronaries... you need oxygenated blood down there. And a lipid sink needs volume to extract and bind the local.

 

[Hoya11]

Hypothetically, let's say you're in a Cath Lab and local anaesthetic was mistaken for contrast and injected directly into the coronaries. The patient immediately arrests. Thoughts on intralipid directly into the coronaries while awaiting ECMO/retrieval?

It sounds like a really dumb idea... But I just can't shake the thought

no to intralipid but i bet a massive saline flush out would help a lot

 

[T-burglar]

Flush coronary with heparinized arterial blood
How fast do your cardiologists place cannulas

 

[pgg]

In general, injecting anything directly into an artery that goes straight to a capillary bed without dilution/mixing with blood in the right heart, unless that substance is specifically intended for arterial injection, is a bad idea.

The osmolarity difference between the substance and normal blood can be very damaging to those single-cell-thick capillaries. Check out all the images of accidental arterial injections when someone pushes something through an arterial line. It's generally not the drug itself doing the damage pharmacologically.

 

[abolt18]

In general, injecting anything directly into an artery that goes straight to a capillary bed without dilution/mixing with blood in the right heart, unless that substance is specifically intended for arterial injection, is a bad idea.

The osmolarity difference between the substance and normal blood can be very damaging to those single-cell-thick capillaries. Check out all the images of accidental arterial injections when someone pushes something through an arterial line. It's generally not the drug itself doing the damage pharmacologically.

NP pushed phenylephrine directly into an art line thinking it was the IV (how he felt qualified to do this, I'll never know). That hand turned WHITE for a solid 30 minutes.

 

[Arch Guillotti]

NP pushed phenylephrine directly into an art line thinking it was the IV (how he felt qualified to do this, I'll never know). That hand turned WHITE for a solid 30 minutes.

Could happen to anybody. One of the most conscientious attendings from my residency accidentally induced someone through a femoral art line.

 

[nimbus]

Could happen to anybody. One of the most conscientious attendings from my residency accidentally induced someone through a femoral art line.

How?? Was there an injection port on the Aline? Did he induce through a stopcock?

 

[Greenbayslacker]

Had a coresident in residency hook up a propofol pump to an a-line. Guy lost his hand.

 

[MirrorTodd]

Had a coresident in residency hook up a propofol pump to an a-line. Guy lost his hand.

Did he ever find it?

 

[DesiredMemberName?]

We had someone run a prop infusion through a lumbar drain. There were no adverse effects that anyone could identify. The dept chair was not interested in publishing a case report.

 

[pocafx]

Vanc into a block catheter. Found it pretty quick no bad effects

 

[Arch Guillotti]

Was there an injection port on the Aline? Did he induce through a stopcock?

yes

 

[Bertelman]

How?? Was there an injection port on the Aline? Did he induce through a stopcock?

I never like inducing through the stopcock, but this may be my new reason why

 

[Bertelman]

Vanc into a block catheter. Found it pretty quick no bad effects

I’ll one-up you.

Vanc into an epidural + 1/8 bupiv into an IV.

 

[woopedazz]

Reminds me of the nearby obstetric patient who was on the receiving end of chlorhex down the epidural.

 

[nimbus]

yes

Was he doing the case himself or was it a “walk in, induce, walk out” situation? It’s our responsibility to keep our lines straight. It’s anesthesia 101, we learn this in the first weeks of CA-1 year.

 

[T-burglar]

I don’t know how anyone picks up pressure tubing and feels the stiffness of it and then their next thought is “ this is a line I should push drugs through”

 

[PpfSuxTube]

I don’t know how anyone picks up pressure tubing and feels the stiffness of it and then their next thought is “ this is a line I should push drugs through”

I didn't want to say it and bring down bad karma on myself but they're very different.

We have vip ports on our Swans so on a manifold there's 4 or 5 sites in close proximity to the aline transducer that we use to push meds and still this mistake hasn't happened at staff level in our facility...

 

[anaesthetic]

I didn't want to say it and bring down bad karma on myself but they're very different.

We have vip ports on our Swans so on a manifold there's 4 or 5 sites in close proximity to the aline transducer that we use to push meds and still this mistake hasn't happened at staff level in our facility...

There's one particular arterial line setup at one random hospital I can't remember now that has a stopcock on the arterial line, and it looks exactly how any other stopcock would look except it's colored red at the tip. Very easy to do in a rush. I had a couple of attendings tape those stopcocks off completely when I was a resident which, in hindsight, makes total sense if you're in a training program with residents/SRNAs.

 

[pgg]

I don’t know how anyone picks up pressure tubing and feels the stiffness of it and then their next thought is “ this is a line I should push drugs through”

Sometimes the brain sees what it expects to see and not what's really there. Vigilance is most of the answer but engineering / physical controls are important.

Epidural tubing should be yellow and have no ports.

In a perfect world pressure tubing should be colored also.

 

[MirrorTodd]

Sometimes the brain sees what it expects to see and not what's really there. Vigilance is most of the answer but engineering / physical controls are important.

Epidural tubing should be yellow and have no ports.

In a perfect world pressure tubing should be colored also.

I could be wrong, but I'm pretty sure I've seen some pressure tubing with a thin red line going down both sides. Might be the Mandela effect though.

 

[Ronin786]

If you have a triple transducer (PA/CVP/Art), all the stopcocks can be exactly the same. I've definitely come close to it quite recently as I was trying to induce through the CVP in a sick patient in the ICU.

 

[GassYous]

I put sux stickers on the a line port

 

[nimbus]

I put sux stickers on the a line port

I put pink tape over any ports on a vasoactive infusion or any extra stopcock on an aline. I do leave the transducer stopcock claved.