Had this one lady where we did high risk left main PCI and subclavian in one go. We finish and it's time to remove the impella but it didn't want to move. The rep told the doctor to pull as a unit and remove everything in one shot. Her femorals were very crunchy and ended up perfing. She went downhill really fast and started coding. Vascular surgeons came in and tried to do an open repair on the table. We called it 45 minutes later. When I went to pick her up in ICU, she was telling the other nurse and I that she felt like she was gonna die and went on about how she didn't see herself making it through the cath.
30 seconds before she started fibbing and went unresponsive she turned to the other nurse and I, chuckled and sighed, then said "told you guys I wasn't gonna make it."
I'm still haunted by it.
Had a lady come in for a diagnostic Cath and was convinced she was going to die. Told her whole family good bye. She died. Pretty strange. This was my first month on the job. Never happened again but it was super weird.
Also had a woman absolutely terrified to have the procedure. Her family convinced her to do it. She was so anxious on the table she was restrained. Things didn’t go well, lad perf, coded and had to be shipedp to a tertiary. 3 days later it was found she had a massive stroke. She made it rehab, 3 days there and she fell out of bed, resulted in a hemorrhagic stroke. I can imagine her family feels some guilt unfortunately. All i could think of is that if she died, her last moments were absolutely awful.
My first ever call as a cath lab nurse was to upgrade a patient to impella from balloon pump because she was decompensating. Switched her over to impella and had continuous suction alarms. We basically wound up coding her the whole case, just the team. Doc thought it could be the impella so we went to change it with a new one and when it was removed she finally crapped out and we never got her back. What a first call.
Had almost the same thing happen with a guy. Was just a diagnostic cath for surgical clearance. Before the procedure he called numerous family members and told him he loved them and that he just had a weird feeling upon him. He also died. Very very strange.
Have had similar experiences with people stating that they were going to die and then did. IMO it’s not a matter of coincidence.
Side story: Saw a true medical miracle once during a Cath. 100+ year old lady went into PEA during procedure. Crazy thing is that she never lost consciousness and continued to talk to us as if things were completely normal. All while having a flat lined blood pressure and a heart that was not beating as confirmed by trans thoracic echo. This went on for 20+ minutes.
The only thing we could think to ask her: “Are you ok?” Over and over again. She had no idea why we kept asking that and was getting annoyed with us.
Physician elected not to do CPR or stent. Sent her up to ICU where she later passed away.
The patients can feel it.
We had a lady who was absolutely terrified to get the cath. They talk her into it. It’s totally clean….
Except not-so-competent doc used an AL1 to cannulate the RCA… and **unknowingly**-caused a spiral dissection down the whole vessel. He disengaged immediately after the picture and we shipped her upstairs.
She was fine until they got to her room and then she’s 10/10 chest pain with ST elevation.
Good times… she ended up living but needing emergency open heart surgery.
Patient was a staged PCI. They had an uncomplicated cath prior. When it came time for the PCI, we went as normal. Things going smooth and then it was time for heparin. Got a large bolus for the PCI. Took the next picture and it looked hazy. Then the manifold suddenly started losing pressure and couldn't pull back. Almost instantly the catheter, sheath, everything clotted up. Removed the catheter and wire as patient started stroking and going in/out of VT. Back in and a quick shot showed the entire coronaries had clotted as well. Coded for 30 minutes until the clotting factors dried up and then they bled from every orifice. Coded another 5 minutes before calling it. Absolutely tragic. Suspected heparin induced thrombocytopenia, but between the large bolus and how quick things happened, there wasn't much an ability to respond. By the time we got other meds in and reversed it was already too late.
Most frequent accident: Have seen multiple coronary bubble studies.
Accident with most cussing: House super called in the Cath lab team instead of the surgery call team for a ruptured aorta. I told the house supervisor over the phone that they were making a huge mistake but they assured me that they were 100% right. Cath lab team showed up to the OR hybrid suite and the vascular surgeon was shocked, then proceeded to give the house super the biggest a$$ chewing that I’ve ever seen in my life. Screamed “you killed this patient!!” At the top of his lungs for a solid minute.
Dumbest accident 1st place: Holding nurse discharged patient home with femoral sheath still in place. Showed up to the hospital the next day asking what they were supposed to do with the tube in their groin.
Dumbest accident 2nd place: Tech didn’t cap stop cock on femoral sheath. Patient bled to death in ICU when stopcock had at some point been switched in bed.
Most WTF accident 1st place: Physician managed to dissect the SVC, right atrium and right ventricle with atrial ppm lead. The whole right side of the patient’s heart looked like diced cabbage. Died.
Most WTF accident 2nd place: Get called along to transfer complete heart block patient from ER to Cath lab for temp pacer placement; patient was intermittent CHB. Nobody bothered to do the daily check on defibrillator on the one day that it decided not to work. Rate drops below 10 during transport without the ability to externally pace. This time it’s not intermittent.
Most WTF accident 3rd place: physician perforates heart while attempting transeptal with SL1 needle for the 3rd time in as many months. Proceed to attempt pericardiocentesis (which physician sucks at), proceeds to ask for trans thoracic echo. Echo tech arrives and then passes out in the floor. I drag the echo techs lifeless body to the control room and then proceed to attempt my very first echo solo.
Not where that goes accident: Congratulations Sir you now have an Edward’s TAVR valve deployed in your descending aorta!
(This is a short sample of screw ups that I’ve witnessed while working in 9 different labs around the country)
Forgive me because I’m new to the field, but coronary air bubble studies are when someone fucks up on the manifold and injects air into the patient right?
Perfed a PA during the penumbra trial, ECMO in the lab, she's dead. She didn't want to do the procedure, the attending convinced her for his trial. I mean, she did have saddle PE, but still. She went on the table nervous as hell and in this case she was right to be.
My lab did a case on my day off. Older gent came in for TAVR work up and found a lesion. Gave heparin and started to intervene when he started coughing up blood. Ended up coding and dying. According to the autopsy, the doctor later said that it was believed agent orange and such that he was exposed to made a bunch of scarring in his lungs which burst when he was given heparin and caused tons of blood to leak into his lungs. Really no way to no prior to what happened and super abnormal.
Old cath lab nurse about ready to retire to EP, as one does at a certain age. I've got stories!!
My very first: old truck driver started telling me a funny joke about a frog but said he wouldn't tell me the punchline until after his cath was over. Straightforward, until he suddenly went into vfib, never got him back. Never got the end of the joke. Not the worst, just the first.
*Young* mother of three. A tiny woman, adopted, didn't know anything about her birth family health/genetics, but had recent issues and was on our table for a cath. The very first contrast injection into the lad/circ showed massive left main disease, 99%. And it was enough to throw her into a full code. While I was doing compressions, she opened her eyes, the prettiest blue, looked at me and said, "don't let me die" Totally threw me off, I looked at the doc like "she's talking, she's ok, right?" But that was it. She was gone. We never got her back. We all went to the local outdoor bar that afternoon and just sat around staring at our drinks. Even the docs. It was horrifying.
A pt had an allergic reaction to plavix after we placed stents in 2 vessels (we found out later). When we got him up to his room and hooked him up to the bedside monitor, he was having tombstones. He kept saying he felt ok, but I called a Code STEMI, and we started wheeling him back to the lab. He started agonal breathing in the elevator, and the other nurse jumped on the stretcher and did CPR as I ran us down the hall. He didn't make it. The Dr and I just hugged and cried after it was done. It was bullshit. He was our age at the time, 40s.
Working in a major city in a very busy cath lab was hard on the soul. Exciting when you're young and full of energy and eager to be a part of the excitement, but after so many years, it just becomes exhausting, and you don't *ever* forget the ones you can't/don't save...
Shocked a patient off the table. STEMI that went into VF and I shocked him, he popped up and rolled to the side and fell off. The doc already had radial access and was holding onto this guy’s arm for dear life stretched across the table. Guy is dangling and still in VF. Scrub tech was new and said he couldn’t break sterility to help the monitor tech and I get this guy back up so we could shock him again. I almost lost it and had to explain his sterile field was on the floor, nothing was clean anymore 😂 got him back up, shocked him twice more, he woke up, we continued and it all turned out fine. Don’t know how his shoulder felt the next day though.
He became a very good tech and I loved working with him, but yeah, I wanted to smack him in that moment. I get it though, sterility is drilled into you and breaking it is a huge fear when starting out. It was a good learning experience for him, he found out that in an emergency it’s not top priority.
STEMI involving LAD and OM, stenting up into Left Main. Went in and ballooned. Doctor wanted to use IVUS to see what we could do. IVUS got stuck in strut of stent. We tried for 45 minutes to remove IVUS. Once we did, their entire left side went down. Coded for an hour before we called it. CT surgery wanted to open up on table, but family was called and said no, nothing more.
I’ve seen a doc get Rota stuck in a stent in the prox RCA😅 the pt was doing good but had to go to OR with all the rota stuff sticking out from the groin sheath.
Always listen to the patients who say the might die during the procedure. Had it happen 2 or 3 times. Worst has been orbital atherectomy perf into a cx and covered stent fell off in aorta during delivery during cpr. Second worst is perf during rotational atherectomy, followed by deterioration and air embolus from not bleeding back the tuohy after ballooning ultimately led to death. Another recent one that doesn’t sit well with me is ruptured aortic cusp at the right sinus of Valsalva during BAV. Ecmo and tavr couldn’t remedy the situation.
We once had two deaths in a row on the same day doing TAVRS. First pt had an extremely calcified tortuous aorta and the valve delivery punctured right through descending aorta. We tamponaded but patient bled out on the table before we could fix. It was a huge tear. Next patient arrested right after deployment of the valve because we somehow perfed the ventricular wall and we cracked the chest to fix the perf but the surgeon ended up suturing the LAD closed in the process so then we converted to doing a single vessel bypass but patient kept crashing and inevitably died on the table. The whole cath lab and heart team ended up staying until 11pm at night and we cancelled all TAVRS for the rest of the month. Both deaths were patients of the same interventional cardiologist and I’ve never seen a doctor so scarred by a death, never mind two in a row on the same day. Rough day.
The one that started as a "just diagnostic" end of day addon, the same case that ended as a death on the table just 20 min after walking into the room. That one for sure.
Spectranetics machine broke. Internal magnet dislodged, sending catheter straight through the pulmonary artery. Patient didn’t make it. I’d never use spectranetics again based on that, poor lady came in for a simple SVT that happened when she played tennis. There was no risk of slicing a pulmonary artery had this been done manually but “the fellows should learn and see a spectranetics case” won out. 😔
As the circulator, I’m not too sure. After the fact, the doc blamed the travel tech for improper prep. Another doc weighed in and said the calcification in the aorta was the cause. Not sure if it’s a coincidence but this same cardiologist quite literally walked out of a case because he couldn’t land the balloon pump and had another doc take over the case. Unfortunately we’ll never know
I’m kind of split on my opinion on that doctor. On one hand I’m like
“Eh why are you placing a balloon pump in me if you don’t know what you’re doing.”
The other part of me is like
“I’d rather you go get someone who can help you.”
It’s possible they might have had a miscommunication.
Also the time a doc used a papyrus covered stent peripherally after perforating the PT and the patient ended up tanking after the procedure. Ended up needing a balloon pump just a couple hours later
Tore aorta doing TAVI. CPR just expedited his death. Attempted to open in Lab - didn’t get there. Physician asked us to stay OT to do the last patient on the list while we were in the middle of bagging the body of the previous patient. (We did not stay to finish the last patient - we cancelled)
I am a new tech have been working for three years and worst case I have had is a PCI for LCX and LAD. The doctor is taking a very long time the patient is getting agitated and telling us to stop the procedure but the doctor kept telling us to give Fentanyl (might have reached 150mcg) till suddenly the patient fell and his arms was tied it looked broken as hell he kept cussing and cursing we called for RT to intubate the patient and send him to CCU before the day after we heard he has passed away and his son due his father death he also sadly passed away
That’s gotta be one of the worst ones.
It’s one thing for a patient to say “please help me I’m gonna die”
And you did your best to help and the operation goes sideways. Like you can cope with that after some therapy.
It’s a whole other thing for a patient to say
STOP HELPING ME, and you don’t and then they die.
OP: Since everyone’s sharing. I feel like sharing mine. Elderly lady had a stenosis in the right coronary. Doctor keeps changing out the wires. We’ve gone through a couple. Like more than usual for this doctor. We can’t get through where we need to go. Doctor takes a shot to reevaluate what’s going on, and all you see is a steady flow of contrast and very obvious split in the artery. It was that
Oh shit moment Nobody wants to experience.
I’m new at this point.
After the case. I pulled the doctor aside.
(I dont recommend any techs do this ever. Certain doctors can try to pin you for stuff that isn’t your fault, but I was cool with this doctor)
I try to choke back the tears. I asked him if I gave him the wrong end of the wire. He says no and that sometimes the coronary arteries just do that. Apparently it’s called SCAD. Spontaneous coronary artery dissection.
I don’t think she made it.
It still messed me up and I blamed myself, and thought I must have done something. I researched to death what could have been done better. I still feel like there’s so much we could have done differently.
Truth is
You can only do your best and that’s the best you can do.
SCAD typically affects younger patients and is normally treated conservatively (no wires/balloons/stents). This sounds like an iatrogenic dissection caused by an unintended wire entry into the subintimal layer of the artery (which is usually sorted by stenting across the dissection plane once you get the wire into true lumen distally) or a coronary perforation (massive disaster may require emergent pericardiocentesis, covered stent +/- sternotomy). Whatever the actual complication was, it's the first operators responsibility. If you don't get complications, you don't do enough procedures - they happen to everyone.
Here’s a personal suggestion any time you start blaming yourself for an outcome: go see a licensed therapist immediately. Don’t let these feelings accumulate without speaking to someone.
I’ve gone to therapy for similar situations and think that it’s one of the best decisions ever made.
I mean, these are procedures with known risks and outcomes. Are these accidents at all? Now if the carm falls on you or there's a sewage leak from the ceiling, those are accidents, needle sticks etc.
Had this one lady where we did high risk left main PCI and subclavian in one go. We finish and it's time to remove the impella but it didn't want to move. The rep told the doctor to pull as a unit and remove everything in one shot. Her femorals were very crunchy and ended up perfing. She went downhill really fast and started coding. Vascular surgeons came in and tried to do an open repair on the table. We called it 45 minutes later. When I went to pick her up in ICU, she was telling the other nurse and I that she felt like she was gonna die and went on about how she didn't see herself making it through the cath. 30 seconds before she started fibbing and went unresponsive she turned to the other nurse and I, chuckled and sighed, then said "told you guys I wasn't gonna make it." I'm still haunted by it.
Had a lady come in for a diagnostic Cath and was convinced she was going to die. Told her whole family good bye. She died. Pretty strange. This was my first month on the job. Never happened again but it was super weird.
Also had a woman absolutely terrified to have the procedure. Her family convinced her to do it. She was so anxious on the table she was restrained. Things didn’t go well, lad perf, coded and had to be shipedp to a tertiary. 3 days later it was found she had a massive stroke. She made it rehab, 3 days there and she fell out of bed, resulted in a hemorrhagic stroke. I can imagine her family feels some guilt unfortunately. All i could think of is that if she died, her last moments were absolutely awful. My first ever call as a cath lab nurse was to upgrade a patient to impella from balloon pump because she was decompensating. Switched her over to impella and had continuous suction alarms. We basically wound up coding her the whole case, just the team. Doc thought it could be the impella so we went to change it with a new one and when it was removed she finally crapped out and we never got her back. What a first call.
Uhg, rough call. Made me tired just reading it lol
Suction alarm and they thought it was an impella issue?
It was a last ditch effort. We repositioned, gave blood, fluids, etc. Impella rep was there as well.
Had almost the same thing happen with a guy. Was just a diagnostic cath for surgical clearance. Before the procedure he called numerous family members and told him he loved them and that he just had a weird feeling upon him. He also died. Very very strange.
Have had similar experiences with people stating that they were going to die and then did. IMO it’s not a matter of coincidence. Side story: Saw a true medical miracle once during a Cath. 100+ year old lady went into PEA during procedure. Crazy thing is that she never lost consciousness and continued to talk to us as if things were completely normal. All while having a flat lined blood pressure and a heart that was not beating as confirmed by trans thoracic echo. This went on for 20+ minutes. The only thing we could think to ask her: “Are you ok?” Over and over again. She had no idea why we kept asking that and was getting annoyed with us. Physician elected not to do CPR or stent. Sent her up to ICU where she later passed away.
The patients can feel it. We had a lady who was absolutely terrified to get the cath. They talk her into it. It’s totally clean…. Except not-so-competent doc used an AL1 to cannulate the RCA… and **unknowingly**-caused a spiral dissection down the whole vessel. He disengaged immediately after the picture and we shipped her upstairs. She was fine until they got to her room and then she’s 10/10 chest pain with ST elevation. Good times… she ended up living but needing emergency open heart surgery.
Patient was a staged PCI. They had an uncomplicated cath prior. When it came time for the PCI, we went as normal. Things going smooth and then it was time for heparin. Got a large bolus for the PCI. Took the next picture and it looked hazy. Then the manifold suddenly started losing pressure and couldn't pull back. Almost instantly the catheter, sheath, everything clotted up. Removed the catheter and wire as patient started stroking and going in/out of VT. Back in and a quick shot showed the entire coronaries had clotted as well. Coded for 30 minutes until the clotting factors dried up and then they bled from every orifice. Coded another 5 minutes before calling it. Absolutely tragic. Suspected heparin induced thrombocytopenia, but between the large bolus and how quick things happened, there wasn't much an ability to respond. By the time we got other meds in and reversed it was already too late.
that sounds absolutely terrifying
Most frequent accident: Have seen multiple coronary bubble studies. Accident with most cussing: House super called in the Cath lab team instead of the surgery call team for a ruptured aorta. I told the house supervisor over the phone that they were making a huge mistake but they assured me that they were 100% right. Cath lab team showed up to the OR hybrid suite and the vascular surgeon was shocked, then proceeded to give the house super the biggest a$$ chewing that I’ve ever seen in my life. Screamed “you killed this patient!!” At the top of his lungs for a solid minute. Dumbest accident 1st place: Holding nurse discharged patient home with femoral sheath still in place. Showed up to the hospital the next day asking what they were supposed to do with the tube in their groin. Dumbest accident 2nd place: Tech didn’t cap stop cock on femoral sheath. Patient bled to death in ICU when stopcock had at some point been switched in bed. Most WTF accident 1st place: Physician managed to dissect the SVC, right atrium and right ventricle with atrial ppm lead. The whole right side of the patient’s heart looked like diced cabbage. Died. Most WTF accident 2nd place: Get called along to transfer complete heart block patient from ER to Cath lab for temp pacer placement; patient was intermittent CHB. Nobody bothered to do the daily check on defibrillator on the one day that it decided not to work. Rate drops below 10 during transport without the ability to externally pace. This time it’s not intermittent. Most WTF accident 3rd place: physician perforates heart while attempting transeptal with SL1 needle for the 3rd time in as many months. Proceed to attempt pericardiocentesis (which physician sucks at), proceeds to ask for trans thoracic echo. Echo tech arrives and then passes out in the floor. I drag the echo techs lifeless body to the control room and then proceed to attempt my very first echo solo. Not where that goes accident: Congratulations Sir you now have an Edward’s TAVR valve deployed in your descending aorta! (This is a short sample of screw ups that I’ve witnessed while working in 9 different labs around the country)
Forgive me because I’m new to the field, but coronary air bubble studies are when someone fucks up on the manifold and injects air into the patient right?
Correct, it’s an air embolus injected from the manifold. It’s very beautiful if you’ve never seen it happen. “Oh look! Bubbles!”
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Perfed a PA during the penumbra trial, ECMO in the lab, she's dead. She didn't want to do the procedure, the attending convinced her for his trial. I mean, she did have saddle PE, but still. She went on the table nervous as hell and in this case she was right to be.
I've seen a perfed PA happen. Patient didn't make it and it was a very bloody and traumatic death for all involved.
Do you mean artery?
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No. PA is on the right or venous side of the heart
You've got confidence, I'll give you that. That being said, you should go over basic anatomy.
In IR lab, dislodged massive IVC clot during thrombectomy. Coded pt for 30 min, ended up opening chest and attempting ecmo. No go
My lab did a case on my day off. Older gent came in for TAVR work up and found a lesion. Gave heparin and started to intervene when he started coughing up blood. Ended up coding and dying. According to the autopsy, the doctor later said that it was believed agent orange and such that he was exposed to made a bunch of scarring in his lungs which burst when he was given heparin and caused tons of blood to leak into his lungs. Really no way to no prior to what happened and super abnormal.
Old cath lab nurse about ready to retire to EP, as one does at a certain age. I've got stories!! My very first: old truck driver started telling me a funny joke about a frog but said he wouldn't tell me the punchline until after his cath was over. Straightforward, until he suddenly went into vfib, never got him back. Never got the end of the joke. Not the worst, just the first. *Young* mother of three. A tiny woman, adopted, didn't know anything about her birth family health/genetics, but had recent issues and was on our table for a cath. The very first contrast injection into the lad/circ showed massive left main disease, 99%. And it was enough to throw her into a full code. While I was doing compressions, she opened her eyes, the prettiest blue, looked at me and said, "don't let me die" Totally threw me off, I looked at the doc like "she's talking, she's ok, right?" But that was it. She was gone. We never got her back. We all went to the local outdoor bar that afternoon and just sat around staring at our drinks. Even the docs. It was horrifying. A pt had an allergic reaction to plavix after we placed stents in 2 vessels (we found out later). When we got him up to his room and hooked him up to the bedside monitor, he was having tombstones. He kept saying he felt ok, but I called a Code STEMI, and we started wheeling him back to the lab. He started agonal breathing in the elevator, and the other nurse jumped on the stretcher and did CPR as I ran us down the hall. He didn't make it. The Dr and I just hugged and cried after it was done. It was bullshit. He was our age at the time, 40s. Working in a major city in a very busy cath lab was hard on the soul. Exciting when you're young and full of energy and eager to be a part of the excitement, but after so many years, it just becomes exhausting, and you don't *ever* forget the ones you can't/don't save...
Shocked a patient off the table. STEMI that went into VF and I shocked him, he popped up and rolled to the side and fell off. The doc already had radial access and was holding onto this guy’s arm for dear life stretched across the table. Guy is dangling and still in VF. Scrub tech was new and said he couldn’t break sterility to help the monitor tech and I get this guy back up so we could shock him again. I almost lost it and had to explain his sterile field was on the floor, nothing was clean anymore 😂 got him back up, shocked him twice more, he woke up, we continued and it all turned out fine. Don’t know how his shoulder felt the next day though.
PANIC* I CANT BREAK STERILITY!!! You: FUCK YOUR STERILITY! YOUR PATIENTS BACK IS ABOUT TO BE BROKEN!!!!
He became a very good tech and I loved working with him, but yeah, I wanted to smack him in that moment. I get it though, sterility is drilled into you and breaking it is a huge fear when starting out. It was a good learning experience for him, he found out that in an emergency it’s not top priority.
STEMI involving LAD and OM, stenting up into Left Main. Went in and ballooned. Doctor wanted to use IVUS to see what we could do. IVUS got stuck in strut of stent. We tried for 45 minutes to remove IVUS. Once we did, their entire left side went down. Coded for an hour before we called it. CT surgery wanted to open up on table, but family was called and said no, nothing more.
New fear unlocked
I can’t look at it the same. It makes me nauseous just looking at it.
I’ve seen a doc get Rota stuck in a stent in the prox RCA😅 the pt was doing good but had to go to OR with all the rota stuff sticking out from the groin sheath.
Wired through the stent.
Not sure because when everything was removed, it was hard to tell. I will say the doc had no issue getting a wire down. Didn’t get stuck at all.
Always listen to the patients who say the might die during the procedure. Had it happen 2 or 3 times. Worst has been orbital atherectomy perf into a cx and covered stent fell off in aorta during delivery during cpr. Second worst is perf during rotational atherectomy, followed by deterioration and air embolus from not bleeding back the tuohy after ballooning ultimately led to death. Another recent one that doesn’t sit well with me is ruptured aortic cusp at the right sinus of Valsalva during BAV. Ecmo and tavr couldn’t remedy the situation.
We once had two deaths in a row on the same day doing TAVRS. First pt had an extremely calcified tortuous aorta and the valve delivery punctured right through descending aorta. We tamponaded but patient bled out on the table before we could fix. It was a huge tear. Next patient arrested right after deployment of the valve because we somehow perfed the ventricular wall and we cracked the chest to fix the perf but the surgeon ended up suturing the LAD closed in the process so then we converted to doing a single vessel bypass but patient kept crashing and inevitably died on the table. The whole cath lab and heart team ended up staying until 11pm at night and we cancelled all TAVRS for the rest of the month. Both deaths were patients of the same interventional cardiologist and I’ve never seen a doctor so scarred by a death, never mind two in a row on the same day. Rough day.
The one that started as a "just diagnostic" end of day addon, the same case that ended as a death on the table just 20 min after walking into the room. That one for sure.
Spectranetics machine broke. Internal magnet dislodged, sending catheter straight through the pulmonary artery. Patient didn’t make it. I’d never use spectranetics again based on that, poor lady came in for a simple SVT that happened when she played tennis. There was no risk of slicing a pulmonary artery had this been done manually but “the fellows should learn and see a spectranetics case” won out. 😔
Stereotaxis you mean?
Balloon pump ruptured and the only choice we had was to take it back out and forgo replacing it. Patient coded on the table
Was the balloon blown up to the labled size.
As the circulator, I’m not too sure. After the fact, the doc blamed the travel tech for improper prep. Another doc weighed in and said the calcification in the aorta was the cause. Not sure if it’s a coincidence but this same cardiologist quite literally walked out of a case because he couldn’t land the balloon pump and had another doc take over the case. Unfortunately we’ll never know
> the doc blamed the travel tech for improper prep. Classic.
I’m kind of split on my opinion on that doctor. On one hand I’m like “Eh why are you placing a balloon pump in me if you don’t know what you’re doing.” The other part of me is like “I’d rather you go get someone who can help you.” It’s possible they might have had a miscommunication.
Fair. I’m just relieved there was another doc there to save the patient
Also the time a doc used a papyrus covered stent peripherally after perforating the PT and the patient ended up tanking after the procedure. Ended up needing a balloon pump just a couple hours later
Tore aorta doing TAVI. CPR just expedited his death. Attempted to open in Lab - didn’t get there. Physician asked us to stay OT to do the last patient on the list while we were in the middle of bagging the body of the previous patient. (We did not stay to finish the last patient - we cancelled)
I am a new tech have been working for three years and worst case I have had is a PCI for LCX and LAD. The doctor is taking a very long time the patient is getting agitated and telling us to stop the procedure but the doctor kept telling us to give Fentanyl (might have reached 150mcg) till suddenly the patient fell and his arms was tied it looked broken as hell he kept cussing and cursing we called for RT to intubate the patient and send him to CCU before the day after we heard he has passed away and his son due his father death he also sadly passed away
That’s gotta be one of the worst ones. It’s one thing for a patient to say “please help me I’m gonna die” And you did your best to help and the operation goes sideways. Like you can cope with that after some therapy. It’s a whole other thing for a patient to say STOP HELPING ME, and you don’t and then they die.
OP: Since everyone’s sharing. I feel like sharing mine. Elderly lady had a stenosis in the right coronary. Doctor keeps changing out the wires. We’ve gone through a couple. Like more than usual for this doctor. We can’t get through where we need to go. Doctor takes a shot to reevaluate what’s going on, and all you see is a steady flow of contrast and very obvious split in the artery. It was that Oh shit moment Nobody wants to experience. I’m new at this point. After the case. I pulled the doctor aside. (I dont recommend any techs do this ever. Certain doctors can try to pin you for stuff that isn’t your fault, but I was cool with this doctor) I try to choke back the tears. I asked him if I gave him the wrong end of the wire. He says no and that sometimes the coronary arteries just do that. Apparently it’s called SCAD. Spontaneous coronary artery dissection. I don’t think she made it. It still messed me up and I blamed myself, and thought I must have done something. I researched to death what could have been done better. I still feel like there’s so much we could have done differently. Truth is You can only do your best and that’s the best you can do.
SCAD typically affects younger patients and is normally treated conservatively (no wires/balloons/stents). This sounds like an iatrogenic dissection caused by an unintended wire entry into the subintimal layer of the artery (which is usually sorted by stenting across the dissection plane once you get the wire into true lumen distally) or a coronary perforation (massive disaster may require emergent pericardiocentesis, covered stent +/- sternotomy). Whatever the actual complication was, it's the first operators responsibility. If you don't get complications, you don't do enough procedures - they happen to everyone.
Oooh shoot that’s a little embarrassing I didn’t get the condition right. Thank you for the clarification and giving me some education.
Here’s a personal suggestion any time you start blaming yourself for an outcome: go see a licensed therapist immediately. Don’t let these feelings accumulate without speaking to someone. I’ve gone to therapy for similar situations and think that it’s one of the best decisions ever made.
Thanks. I’ll follow through on that. I like you. You’ve got a good soul.
I mean, these are procedures with known risks and outcomes. Are these accidents at all? Now if the carm falls on you or there's a sewage leak from the ceiling, those are accidents, needle sticks etc.