by Bo Liu, MD. Dr. Liu is a radiology resident who blogs at http://futureproofmd.com/
Imagine this: you are on your 2nd IR rotation. You learned a lot during your first rotation and you feel pretty solid about your skills at basic vascular access. You haven’t timed yourself but you’re pretty sure you can throw in a port in 20 mins or less. You just got done with a really long day assisting on 2 TIPS and 1 very difficult adrenal vein sampling. Your back is achy; your legs are rubber. You finally took off your lead and sit down. Your tech comes by to drop off the schedule for tomorrow. You start going through the list to put in all the pre-orders and you see a Trifusion catheter scheduled for a 25-year- old patient. You say to yourself: “Oh it’s just a Trifusion. I don’t need to look this patient up. What could possibly go wrong?” You put in the pre-orders and go home. You come back the next morning and get the cases rolling. You are hitting every note and turning over the rooms like champ. You are feeling good, then you hit that 25-year- old patient who you didn’t bother to look up because “what could possibly go wrong?” You gain internal jugular access without a hitch but no matter how hard you tried, you couldn’t get the microwire into the heart. A venogram thru the micropuncture sheath shows central venous stenosis. You call your attending. He calls the clinician. You wait for the clinician to call back. Long story short, you end up placing the Trifusion catheter in the groin after a 45 min delay. The rest of your day is now completed backed up. A brief review of the patient’s medical record yields a CTA chest done just 1 month ago which clearly demonstrated central venous stenosis.
In case it’s not abundantly clear by now – the resident in this “imagined“ situation is me. I made the same mistake that so many have made before and even more will repeat after. You may have heard fellows or senior residents say “It’s just a port,” “just a permcath” etc. Because 90% of the time you will be completely fine. But it’s the 10% of the time that will get you. We owe it to our patients, our attendings, and most importantly ourselves to take the 5 minutes we need to review the case and any relevant prior imaging. So residents on IR, do yourself a favor and never let “it’s just a ______” enter your thoughts.