Healing Doctor

Chapter 327 Knotting

Director Qian of the ICU nervously pushed open the door to report the situation.

"Director Bai, the patient has a problem."

"Speak," Director Bai said succinctly.

"The patient just experienced refractory hypotension. The vasopressor was ineffective, and we are currently administering intravenous fluids."

"What about attracting traffic?"

"Drawing in the patient is no problem; I gave them norepinephrine."

Director Bai got up, put on a sterile cap and mask, and went to the ICU with Director Qian.

Under the influence of norepinephrine, the patient's blood pressure began to rise. Instead of blaming Director Qian, Director Bai stood by the bedside with his hands behind his back, carefully observing the patient.

The situation was not as stable as before. Under the influence of norepinephrine, the patient's blood pressure did return, but it did not stay at the normal value or at a slightly higher level.

血压像是过山车一样，高压从70毫米汞柱升到80，再到90、100、130、150，最后定格在183毫米汞柱附近。

"There's a problem with the waveform of the Swan-Ganz catheter."

The heads of the cardiology and cardiac surgery departments both noticed this and gave a joint reminder.

Seeing that Director Bai remained silent, Director Qian began to busy himself with his own tasks.

After stopping the norepinephrine, Director Qian discussed the matter with Director Zhang of the Cardiac Surgery Department and the Director of the Cardiology Department for a few minutes. Then he reported to Director Bai, "Director Bai, the Swan-Ganz catheter may have lost its function. We recommend removing it."

"Take it." Director Bai stepped aside and did not interfere with the clinical work.

Dr. Zhang, the head of cardiac surgery, began inserting a catheter into the right subclavian vein and attempted to remove the Swan-Ganz catheter.

But just as the last section was about to be pulled out, Director Zhang felt a slight resistance. The force was so small that it seemed like a little force would be enough to remove the catheter.

But he was careful not to use brute force to pull out the Swan-Ganz catheter.

The worst thing patients can do after any surgery is to use brute force, because you can't see into someone's heart, and nobody knows what's going on inside.

Director Zhang asked someone to bring over the X-ray machine by the bedside to check what was going on with the Swan-Ganz catheter.

The Swan-Ganz balloon-assisted intubation catheter is a tool for measuring pulmonary artery pressure and pulmonary capillary wedge pressure, and is essential for cardiac surgery.

After the catheter was inserted during the procedure, measurements were taken, but the waveform displayed by the floating catheter was incorrect, and it seemed that there was something wrong with the Swan-Ganz catheter.

After the X-ray was taken, a doctor from the ICU took the film box to the radiology department to have the films developed.

Ten minutes later, Director Bai and others saw the video on the computer.

The moment they saw the image, everyone was stunned.

The head of the Swan-Ganz catheter was knotted... like the first knot in a shoelace.

Seriously damn good!

Director Bai cursed inwardly.

What on earth is going on?! How could such a bizarre thing happen during a perfectly normal heart transplant surgery?!

The Swan-Ganz catheter is tied and inserted through the internal jugular vein, passing through the superior vena cava to the right atrium, right ventricle, and pulmonary artery.

During the removal process, the Swan-Ganz catheter somehow got knotted. What should have been a simple removal of the floating catheter became impossible due to the knot.

The knot wasn't completely tied yet, because Director Zhang was very careful and didn't use brute force in the end. But what good is it if it's not completely tied? The knot has already formed, and there's no way to untie it now.

After seeing the footage, all the experts present fell silent.

The incident happened so suddenly that everyone present was somewhat stunned. The surgery went smoothly, but the problem arose post-surgery, at a seemingly insurmountable knot.

My Swan-Ganz catheter is knotted. What should I do next?

Nobody expected such a tricky situation to occur with a newly transplanted heart.

The experts on the expert panel wanted to curse, especially Director Zhang of the Cardiac Surgery Department, whose face turned red with suppressed anger.

Swan-Ganz catheters are expensive, and few patients can use them, but they are still frequently used in cardiac surgery. Dr. Zhang has seen many patients using Swan-Ganz catheters, but he has never seen one get knotted.

Cursing won't solve the problem; the problem is what to do next.

Several experts from cardiac surgery, circulatory, and critical care fell silent, even Lu Gang, who was known for his high aspirations, remained silent.

No one had ever seen this situation before, and no one knew how to handle it.

Director Bai started making phone calls, calling on relevant directors and experts from the vascular surgery department and other departments to come for a joint consultation.

Accompanying them was Dean Zhao Jixiang.

First, we understood the patient's condition, and then, under the guidance of the head of the ultrasound department using a two-dimensional color ultrasound, we removed the subclavian vein catheter.

At this stage, the patient's vital signs are stable and there are no other complications.

Then comes the question of how to remove the Swan-Ganz catheter.

"Can the vascular surgery department cut open the jugular vein?" Director Bai asked.

"It's very difficult," said Director Wang of the Vascular Department without hesitation. "If we pull it out any further, the knot will become even tighter and thicker, making it hard to guarantee that it won't hit anything when it passes through the jugular vein."

He spoke rather vaguely, but those present understood.

The neck is densely packed with blood vessels and nerves. With such a thick knot running through the jugular vein, it's not too easy for it to encounter some nerve sensor that could cause a sudden cardiac arrest.

"Dean Zhao, what do you think?" Director Bai asked, frowning.

"Let's listen to the experts' opinions," Dean Zhao began, dodging the question.

He himself came from a clinical background, but as an orthopedic surgeon, it wasn't very likely that Zhao Jixiang would offer constructive advice when it came to procedures like heart transplants.

Director Bai was only asking for Dean Zhao's opinion out of respect and to follow the proper procedures.

"Where's Zhao Xiangming? Why hasn't he arrived yet?" Director Bai asked, frowning.

"Director Zhao should be fishing this weekend," said Director Qian of the ICU, knowing Zhao Xiangming's habits and hobbies. "And Director Bai, to put it bluntly, Zhao Xiangming coming wouldn't make a difference."

"We should at least give it a try."

The Swan-Ganz catheter knot is located inside a blood vessel, and interventional radiology is a highly qualified field for this type of procedure.

After a good half hour, Zhao Xiangming arrived, panting heavily.

"Dean Zhao, Director Bai, I'm sorry, the fishing spot is a bit far today," Zhao Xiangming apologized as soon as he arrived.

"Let's see how it goes. Do you think it can be removed?" Director Bai didn't scold anyone, but asked directly.

Zhao Xiangming glanced at the video footage and shook his head vigorously.

"Impossible, absolutely impossible," Zhao Xiangming said. "Although the location is relatively shallow, to untie the knot here, we need to use a guide wire to push the head of the Swan-Ganz catheter out."

"With blood flow involved, addressing the issue point-to-point is practically impossible."

Zhao Xiangming spoke very decisively and resolutely.

"Ugh."

Someone let out a deep sigh.

A Swan-Ganz floating catheter got tangled inside the body—I'd never heard of such an absurd thing before! But this rare situation actually happened. Interventional surgery was definitely not an option. What should we do next?

"Really not going to work?" Director Bai stared at Zhao Xiangming.

"..." Zhao Xiangming concluded, then hesitated for a moment, "Director Bai, let me make a phone call."

(End of this chapter)