r/medicine•
Get_This

Off my chest - I put a central line today, and the patient developed pneumothorax.

I dont know if this is the right sub for this, but fuck it. I feel like I need to vent, and you guys are usually quite supportive.

Background - physician at a large hospital in my country (don't want to reveal more, privacy etc etc). I have had around 4 years of experience in the ICU and ER. I must've put around 100+ central lines, and at my peak, could do it with my eyes closed (figure of speech btw). So, I've been out of active action in the ICU/ER for the past 6 months (personal issues) - and today I got the chance to put a central line in a patient. Easy peasy right. Done this a million times. The patient was hypotensive (MAP 50), and this wasn't USG guided. I prep myself, get in position, but I couldn't feel the carotid pulse at all. I tried the right side for 2 picks, and on the second prick, I felt the pressure give way and I hit bone. I immediately knew I fucked up, and started sweating like a pig. I withdrew the needle, and proceeded to put it in the left side - and I got it in the first prick. Immediate xray was fine, but I knew I had fucked up pretty badly. 6 hours later, I get a (very angry call) from one of the senior team members saying that the patient has developed pneumothorax, and had to undergo ICD insertion as a result, and that I learn from this and not repeat this ever again.

Couple of things here I feel like I want to get off of my chest - this is the first time in my whole career I've had pneumo due while inserting a central line. It felt surreal and heavy. I've seen it happen tons of times, but this is the first time it has happened to me. Yes, it has shaken my confidence a little bit. The relatives of the patient were quite ok when I informed them - I felt really, really bad though. Guilty almost. I was dreading this very complication when I picked up the needle after 6 months, and it happened. I was happy that I got the left side easily at one go, but all of it was down the trash can the moment my worst fears were confirmed. Will I continue to put central lines freely after this? I don't know - maybe I'll ask someone to be with me as a standby.

What do you guys think? Had something like this (not necessarily this complication, but something that shakes your confidence) happen to you? How do you deal with it?

Again, I understand that this may feel like a 'small' inconsequential thing to many, but bear with me. I feel like I need to get this off my chest.

Posted Oct 23, 2017, 3:35 PM UTC

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