Reply to Candice/Lap Chole Basics

Candice said...I'm only in my second week of my Minor Surgeries class but I'm going to take a stab at this one.
First Question: Artery
Second Question: The ST should have already anticipated the need of the clip once the bleeding started
Third Question: (I think) that the ST should be asking if the surgeon needs a larger, more durable clip or if another clip applier should be loaded(?)There you have it (maybe). Even if I'm wrong on all three questions, I just wanted to say thanks for posting this because it was a lot of fun. I love reading your blog and learning the things that I will most likely encounter one day. Keep em' coming!

Candice- Sorry about the HUGE delay.
You are right, number one is an artery as projectile, pulsating bleeding indicates, but more specifically it is the cystic artery. With all of the edema and inflammation it is often difficult to identify any structures and while dissecting, sometimes the artery finds you.

Number two. Again you are right. The surgeon should not have had to prompt the tech into action. Whenever you see bleeding, you should be thinking of what the surgeon is going to need to stop the bleeding. Now of course in order to see the bleeding, you have to PAY ATTENTION!! This tech was dozing off at the mayo stand and not even looking at the monitors.
You often won't be able to see bleeding, as in an open abdominal case where the bleeding may be out of your sight but if you are PAYING ATTENTION you will probably hear something like, "S*#t!", or "Where is that coming from?", or "SUCTION!" or maybe even, "Are we typed and crossed?" If it is a surgeon you often work with, you will probably be familiar with the favorite method of hemostasis and have already opened those supplies. It may be a DeBakey and a clip, a clamp and a stick tie, a clamp and a free tie, and for laparoscopic cases, a horizon clip, or a multi-fire endoclip applier, or even an endo loop, all depends on preference, and the size of the bleeding vessel.

And, number three, you are on the right track. One set of green Horizon clips equals six clips. Four clips had already been applied and there is still bleeding. Stay ahead of the game, ANTICIPATE! The last thing a surgeon wants to do while a patient is trying to lose blood, is nothing, standing there waiting while the tech asks for, the circulator gets (often leaving the room) and opens more supplies. Even if two more clips do the trick, we still need at least six more clips to clip and cut the cystic artery and cystic duct proper (when we actually find them in the giant gooey mess), so what was the tech waiting for? Scrub a vascular case and don't stay one ahead with your 5-0, 6-0 or 7-0 prolene and see how far you get without being less than cheerily chastised!

Great job Candice!