October 11, 2005


It seemed quite straightforward - the pediatric surgery registrar was called to the Neurosurgery ward for a child for whom IV access was difficult and was requested to do a cut down ie insert the canula into a large vein under direct visualisation. Sajjiwent down to do it and I decided to join him as I wanted to learn the procedure. We started confidently in one of the veins aboive the ankle... but slowly things started going against us.
First the girl started moving and shaking and refused to hold still.. and the vein got all frayed and unusable. Sajji persisted and tried cannulating the vein a little higher up... but this time the canula counter-punctured the vein and came out. The tense father lost his cool.. he ranted and raved about how this was getting out of hand and how his daughter was suffering over the last few years and was a burden to him etc etc. We were a little taken aback. Sajji and I explained the options left to him and urged him to be sensible. He finally quitened down and allowed us to proceed with a new cannula and try to cannulate the femoral vein in the inguinal region. This time we deeply sedated the girl and allowed her to go to sleep slowly. Sajji then got back to dissecting out her femoral vein and careflly placed the canula and the catheter into it... he pushed it and it stopped after a few millimeters. Frustration again. I tried flushing the canula and discovered a leak on the side which was probably the reason it was kinking .... Sajji quickly ordered the nurse to get another new canula from the Pharmacy and careflly pulled out the leaking catheter and slid in the new one... it went in!! Our joy seemed short lived however -after a couple of centimeters it stopped. It had reached either a valve or a sharp turn in the vein. We tried all kinds of manouvers and angles and force, but it refused to budge. As we were on the brink of giving up we noticed that blood was flowing slowly out through the catheter - a sure sign that the catheter was in the right path. We persisited and as if by magic... it slowly went past the block and then glided in all the way smoothly!!
Thank God for giving us both patience and persistence - especially Sajji: he was amazingly calm!!
Normally the procedure takes about half an hour. How long did we take? Er.... three and a half hours... ooops!!

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