As mentioned before, the internal jugular vein cannot be selected. If it is vvecmo mode, you may have to choose the left and right femoral veins. In vaecmo mode, you can choose one side of the femoral artery and femoral vein for puncture.
Arteriovenous puncture carries risks.
In order to ensure the success rate of puncture, angiography machines are used to assist in interventional operating rooms.
What to do if there is no angiography 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 doctors to better choose which blood vessel to puncture and locate."
The teachers listened to her suggestions and considered them first.
It is a bit troublesome to push the ultrasound machine to the bedside, and one needs to think whether it is necessary. In theory, there are many doctors in their country who are familiar with this kind of puncture, and it is not necessary to use the machine to assist their doctors in vascular positioning.
Xie Wanying raised another technical question: "If femoral artery catheterization is performed, blood flow to the distal lower limbs must be guaranteed. Once there is a problem, with the help of ultrasound equipment, the problem can be discovered in time and the distal lower limb artery can be closed and perfused to avoid complications."
After hearing what she said, Zhang Huayao, who took the initiative to change the mode, had to look up at her, with shock in his eyes. It can be seen that he really had not considered this issue.
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Don't blame him. Even though he is a big shot, he has never used the machine and is not familiar with all possible clinical complications.
Since Professor Zhang wanted to switch to the vaecmo mode, Xie Wanying had to make some more suggestions: "The membrane lungs and pumps used in the vaecmo and vvecmo modes can be slightly refined if the need to move the patient for emergency treatment is excluded. The vaecmo mode involves cardiac assistance, so it is best to use a centrifugal pump plus a hollow fiber membrane lung. For simple respiratory assistance, a roller pump and a silicone membrane lung can be used."
This time it was Director Wang's turn to listen to her and hurriedly turn around to check if the machine was installed correctly. He didn't seem to have seen these in the manual. Director Wang felt around and took out a notebook to make notes.
The doctors around had already fallen silent. They only saw the two leaders being repeatedly instructed by the stubborn Teacher Xie. The scene was completely speechless.
"All up to you." Zhang Huayao waved his hand and gave instructions briskly.
It can be seen that the boss really doesn't mind being pointed out by Teacher Xie for his mistakes.
Shen Youhuan quickly called the ultrasound department to ask them to bring the machine, because he or Du Yeqing would be the one to do the puncture later.
In fact, there are many other benefits to having an ultrasound machine. For example, the femoral vein catheter should be inserted to the junction of the right atrium and the inferior vena cava, and the length should be 40 to 55 centimeters. If an ultrasound machine is used to detect with a probe, it can more accurately determine whether it is inserted in place.
The machines are arriving one by one.
The ultrasound doctor pushed in the ultrasound machine. The nephrologist pushed in the blood filter machine.
When Dr. Liu from the Nephrology Department arrived, he confessed to Zhang: "I have never done this before, so I don't know how to do it. I didn't even know that our hospital had an ECMO machine before."
Zhang Da Lao pointed at Teacher Xie across from him and said, "You can ask her."
"Where is this teacher from?" Doctor Liu asked the same question as Director Wang, what is the identity of this young man in front of him.
If it weren't for the stare from Boss Zhang that stopped her from saying it, Xie Wanying would have already revealed that she was not a teacher.
"Listen to what she says first." said Boss Zhang.
Your identity doesn’t matter; what matters is getting technical information that can help you save people.
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