Director Qian of the ICU nervously pushed open the door and reported the situation.

"Director Bai, the patient has a problem."

"Say." Director Bai said one word succinctly.

"The patient has just developed intractable hypotension, and the vasopressor has no effect after being given, and he is being rehydrated."

"What about drainage?"

"The drainage was fine, I gave norepinephrine."

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

Under the effect of norepinephrine, the patient's blood pressure began to rise, and Director Bai did not blame Director Qian, but stood at the head of the bed with his hands behind his back and looked carefully.

The situation was not as smooth as before, and the patient's blood pressure did return under the effect of norepinephrine, but it did not stop at the normal value or slightly higher than the normal value.

Blood pressure is a roller coaster, with high pressure rising from 70 mm Hg to 80, then to 90, 100, 130, 150, and finally around 183 mm Hg.

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

The directors of the Department of Cardiac Medicine and the Department of Cardiac Surgery both noticed this, and they both reminded in unison.

Director Qian saw that Director Bai didn't speak, so he started to get busy.

After stopping norepinephrine first, Director Qian discussed with Director Zhang of the Department of Cardiac Surgery and Director of the Department of Cardiology for a few minutes, and reported to Director Bai, "Bai, the Swan-Ganz catheter may have lost its effect, and it is recommended to take it out." ”

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

Director Zhang of the Department of Cardiac Surgery began to insert the right subclavian venous catheter and attempted to remove the Swan-Ganz catheter.

But the last paragraph was about to be pulled out, and Director Zhang felt a slight resistance. That force is so small that it seems like a little force can get the catheter out.

But he was careful not to use brute force to pull the swan-ganz catheter out.

The most taboo for patients after various surgeries and postoperatives is to use brute force, because people are separated from the belly, and no one knows what is going on inside.

Director Zhang asked someone to push the bedside X-ray machine to see what was going on with the swan-ganz catheter.

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

After the operation, I went down and measured it, but the waveform displayed by the floating catheter was not correct, and no matter how I looked at it, I felt that there was a problem with the Swan-Ganz catheter.

After the filming, a doctor in the ICU went to the radiology department with the film box to wash the film.

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

The moment they saw the image, everyone was stunned.

Swan-ganz catheter head punched a knot...... It's like tying the first knot of your shoes.

It's amazing!

Director Bai scolded in his heart.

What's going on! A good heart transplant, how did such a strange thing happen!

The swan-ganz catheter is knotted and enters through the internal jugular vein through the superior vena artery to the right atrium, right ventricle, and pulmonary artery.

During the process of taking it out, the swan-ganz catheter didn't know what was going on and actually tied a knot. The floating catheter, which could have been easily removed, could not be removed because of a knot.

The knot was not killed yet, because Director Zhang was very careful and did not use brute force in the end. But what if you don't die? The pattern has been formed, and nothing is working.

After seeing the film, everyone in the expert group present was silent.

The incident happened suddenly, and everyone present was a little confused. The operation went well, but the problem appeared after the operation, on a dead knot.

The Swan-Ganz catheter is knotted, what happens next?

With a newly transplanted heart, no one would have expected such a tricky thing.

The experts of the expert group wanted to curse, especially Director Zhang of the Department of Cardiac Surgery, whose face was even redder.

The Swan-Ganz catheter is expensive and can be used by few patients, but it is still often used in cardiac surgery. Director Zhang has seen many patients use swan-ganz catheters, but he has never seen knots.

Scolding doesn't solve the problem, the question is what to do next.

Several experts in extracardiac, circulation, and critical illness were silent, and even Lu Gang, whose eyes were above the top, did not speak.

No one had ever seen this situation before, and they didn't know what to do about it.

Director Bai began to make phone calls and brought the relevant chief experts from the vascular department and other departments for consultation.

With them, there is also Zhao Jixiang and Dean Zhao.

The condition was first understood, and then the subclavian venous catheter was removed under the guidance of the director of the B-ultrasound room with two-dimensional color ultrasound.

By this step, the patient's vital signs were stable and there were no other complications.

Then it's how to get the swan-ganz catheter out.

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

"It's hard." Director Wang of the vascular department said without hesitation, "If you pull it out again, the knotted part will be tighter, and the diameter is very thick, and it is difficult to ensure that you don't touch anything when passing through the jugular vein." ”

He said it in a more general way, but those present knew it.

The blood vessels and nerves in the neck are dense, and it is not too easy to walk in the jugular veins with such a thick knot as if you encounter a nerve sensor that causes sudden cardiac arrest.

"Dean Zhao, look at it." Director Bai asked with a frown.

"Listen to the experts." Dean Zhao began to do Tai Chi.

He himself is clinical, but when it comes to heart transplantation, it is not very likely that Zhao Jixiang will put forward constructive suggestions.

Director Bai was only respectful and went through the process to ask Dean Zhao's opinion.

"Zhao Xiangming, why haven't you come yet!" Director Bai asked with a frown.

"On the weekend, Director Zhao should go fishing." Director Qian of the ICU knew Zhao Xiangming's habits and hobbies, and said helplessly, "And Director Bai, if I say something unpleasant, it's useless for Zhao Xiangming to come." ”

"Always give it a try."

The location of the knot of the Swan-Ganz catheter is in the blood vessels, which involves this procedure, and the amount of the interventional department is sufficient.

After more than half an hour, Zhao Xiangming rushed over panting.

"Dean Zhao, Director Bai, I'm sorry, the fishing place today is a bit far away." After Zhao Xiangming came, he would pay first.

"Look at the situation, do you think you can take it out?" Director Bai didn't scold, but asked directly.

Zhao Xiangming looked at the video materials and shook his head into a rattle.

"Impossible, absolutely impossible." Zhao Xiangming said, "Although the position is relatively shallow, if you want to unfasten the button here, you need to use the guidewire to go in and push the head of the swan-ganz catheter out. ”

"There is an impact on blood flow, and there is basically no such possibility of solving the problem point-to-point."

Zhao Xiangming said very simply and resolutely.

"Ugh."

I don't know who sighed deeply.

The swan-ganz floating catheter is knotted in the body, and this kind of ridiculous thing has never been heard of! But it is such a rare situation that it will definitely not work through interventional surgery, so what should I do next?

"Really?" Director Bai stared at Zhao Xiangming.

"......," Zhao Xiangming concluded, he hesitated, "Director Bai, I'll make a call." ”