Blood
I can remember a time when blood was considered a sacred, life-giving substance. When I was an intern, to get splashed with blood was a part of the job, the only drawback being the need to use hydrogen peroxide to remove the stains from clothing. Now we look upon blood with the same dread we hold for toxic or radioactive waste. Health care providers cover themselves with gowns, masks, eyeshields and gloves, and tremble at the thought of getting sprayed with the stuff.
I did get hepatitis B when I was an intern, presumably from blood exposure, but after 4 or 5 weeks spent laying on the bathroom floor vomiting, I was good to go. Nowadays the risks are greater: Hep B, Hep C and HIV. I used to get stuck with a needle two or three times a year, anyone who does a lot of invasive procedures will. Lately I will admit to being more cautious. Knock on wood, but I haven't been stuck or sprayed in at least 6 months.
The patient was an unfortunate young woman who, as we say, was behind the door when luck was being handed out. She was in her twenties, she was HIV positive and had end-stage renal disease. She was on dialysis at one of the local units. Besides practicing critical care medicine, I am also a nephrologist, or kidney specialist. This woman was one of my partner's patients and was admitted in the afternoon with a fever and a tender swollen arm. The infection was in her vascular access for dialysis, basically an artificial blood vessel connecting an artery and vein under the skin in her right upper arm. Three times a week it was stuck with needles and she was hooked up to the artificial kidney to clean the blood. Her access vessel was obviously infected.
I evaluated her, put her on antibiotics and had vascular surgery come see her and do their thing. The surgeon set her up for an operation to remove the infected vessel in the morning and we all went home.
Unfortunately in the early morning hours the infection eroded through the access and she cut loose with a gusher of arterial, HIV-infected blood spraying all over the room. She rapidly developed shock, acidosis, respiratory arrest and basically crashed and burned. I was called in to see her upon transfer to the ICU, and can only imagine the scene with the brave nurses and house doc trying to control the bleeding while terrified of getting exposed to the blood that was flooding the room. They basically had to call a Haz-Mat team to decontaminate and clean up.
In the ICU I had to place a central line, arterial line and a dialysis catheter. Her labs showed severe acidosis and increased potassium, such that she was only minutes away from a cardiac arrest. With great trepidation I approached the patient, double-gloved, eye shield in place, gown on. I cleared the nurses away so no one accidently stuck me and placed the needed lines. When I finished with each needle I dropped it into a sharps box and tried not to make sudden moves or grabs, but blood was everywhere and by the time I was done and the patient was running on dialysis I was drenched in sweat and drained.
The patient needed frequent blood draws, cleaning, suctioning of the ETT, and I was amazed at how the nursing and technician staff calmly went about their jobs. Brave souls indeed. The family was also calm and accepting of the complications and treatments. I think they had been through a lot with this woman already. They seemed to realize that her days were numbered and each time the Angel of Death was beaten it was only a temporary reprieve, a rear-guard action.
Home, bed, sleep.
I did get hepatitis B when I was an intern, presumably from blood exposure, but after 4 or 5 weeks spent laying on the bathroom floor vomiting, I was good to go. Nowadays the risks are greater: Hep B, Hep C and HIV. I used to get stuck with a needle two or three times a year, anyone who does a lot of invasive procedures will. Lately I will admit to being more cautious. Knock on wood, but I haven't been stuck or sprayed in at least 6 months.
The patient was an unfortunate young woman who, as we say, was behind the door when luck was being handed out. She was in her twenties, she was HIV positive and had end-stage renal disease. She was on dialysis at one of the local units. Besides practicing critical care medicine, I am also a nephrologist, or kidney specialist. This woman was one of my partner's patients and was admitted in the afternoon with a fever and a tender swollen arm. The infection was in her vascular access for dialysis, basically an artificial blood vessel connecting an artery and vein under the skin in her right upper arm. Three times a week it was stuck with needles and she was hooked up to the artificial kidney to clean the blood. Her access vessel was obviously infected.
I evaluated her, put her on antibiotics and had vascular surgery come see her and do their thing. The surgeon set her up for an operation to remove the infected vessel in the morning and we all went home.
Unfortunately in the early morning hours the infection eroded through the access and she cut loose with a gusher of arterial, HIV-infected blood spraying all over the room. She rapidly developed shock, acidosis, respiratory arrest and basically crashed and burned. I was called in to see her upon transfer to the ICU, and can only imagine the scene with the brave nurses and house doc trying to control the bleeding while terrified of getting exposed to the blood that was flooding the room. They basically had to call a Haz-Mat team to decontaminate and clean up.
In the ICU I had to place a central line, arterial line and a dialysis catheter. Her labs showed severe acidosis and increased potassium, such that she was only minutes away from a cardiac arrest. With great trepidation I approached the patient, double-gloved, eye shield in place, gown on. I cleared the nurses away so no one accidently stuck me and placed the needed lines. When I finished with each needle I dropped it into a sharps box and tried not to make sudden moves or grabs, but blood was everywhere and by the time I was done and the patient was running on dialysis I was drenched in sweat and drained.
The patient needed frequent blood draws, cleaning, suctioning of the ETT, and I was amazed at how the nursing and technician staff calmly went about their jobs. Brave souls indeed. The family was also calm and accepting of the complications and treatments. I think they had been through a lot with this woman already. They seemed to realize that her days were numbered and each time the Angel of Death was beaten it was only a temporary reprieve, a rear-guard action.
Home, bed, sleep.
posted by ICUDOC at 1:19 PM
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