As mentioned before, you cannot choose the internal jugular vein. If you are in vvecmo mode, you may have to choose the left and right femoral veins. In vaecmo mode, you can choose the femoral artery and femoral vein on one side for puncture.
Arteriovenous puncture has risks.
In order to ensure the success rate of puncture, imaging machines are used to assist in interventional operating rooms.
What would you do if you don't have a radiography machine for bedside puncture like this?
Xie Wanying suggested to the teacher: "Use ultrasound equipment to help. It can detect the diameter of the patient's blood vessels, allowing the doctor to better choose which blood vessel to puncture and locate."
The teachers listened to her suggestion and considered it first.
It is a bit troublesome to bring the ultrasound machine to the bedside, which makes people need to think about whether it is necessary. Logically speaking, Guozhi has many doctors who are familiar with doing this type of puncture, so it is not necessarily necessary to use a machine to assist their doctors in locating blood vessels.
In this regard, Xie Wanying raised another technical question: "If femoral artery intubation is performed, the blood supply to the distal lower limbs needs to be ensured. Once there is a situation, with regular ultrasound equipment to detect the problem, the problem can be discovered in time and the distal lower limb arteries can be perfused to avoid it.
Complications occur.”
After hearing what she said, Zhang Huayao, who took the initiative to change the mode, had to raise his head and look at her, his eyes almost bursting with shock. It showed that he really hadn't considered this issue just now.
Don't blame him, even if he is a big boss, he has never used a machine and is not familiar with all possible clinical complications.
Since Teacher Zhang wants to switch to vaecmo mode, Xie Wanying must make some more suggestions: "The membrane lungs and pumps used in vaecmo mode and vvecmo mode can be a little more careful if the need to move the patient in emergency is excluded. Vaecmo mode involves cardiac assistance.
, it is best to use a centrifugal pump and a hollow fiber membrane lung. For simple breathing assistance, a rolling pump and a silicone membrane lung can be used.”
This time, it was Director Wang's turn to listen to her words while he hurriedly turned around and rechecked whether the machine was installed correctly. He didn't seem to have seen these in the manual. Director Wang touched his body and took out his notebook to take notes.
The doctors around them were silent for a long time. They saw the two leaders being instructed repeatedly by the stubborn Teacher Xie. This scene left people completely speechless.
"It's all up to you." Zhang Huayao waved his hand cheerfully and gave instructions.
It can be seen that the boss really doesn't mind having many mistakes pointed out by Teacher Xie.
Shen Youhuan quickly called the ultrasound department to send a machine, because he or Ye Qing should do the puncture later.
In fact, having an ultrasound machine has various other benefits. For example, the punctured femoral vein tube needs to go to the junction of the right atrium and the inferior vena cava, and the length reaches 40 to 55 centimeters. If there is an ultrasound machine using a probe to explore
, maybe you can know more accurately whether it is inserted in place.
The machines are put in place one after another.
The sonographer brought an ultrasound machine. The nephrologist brought a hemofiltration machine.
After Dr. Liu from the Department of Nephrology arrived at the scene, he confessed to Mr. Zhang: "I have never done it before and I don't know how to do it. I didn't even know that our hospital had an ecmo machine before."
Mr. Zhang pointed his hand at Teacher Xie opposite him: "You can ask her."
"Where did she come from as a teacher?" Dr. Liu asked the same question as Director Wang, about the identity of the young boss in front of him.
If it weren't for the fact that Boss Zhang stared at her and refused to say anything, Xie Wanying would have wanted to reveal that she was not a teacher.
"Listen to what she says first." Boss Zhang said.
It doesn't matter what your identity is, what matters is that you can save people by asking for technical information to help you.