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metawikimedia>DrBobGreenberg at 20:16, 8 July 2015

2015-07-08T20:16:53Z

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In preparation for a large craniofacial reconstruction, you elect to place an
internal jugular central line under general anesthesia for your 2 year old patient.
Informed consent has been obtained from the parents. The line is placed under
ultrasound guidance, although you have difficulty obtaining real time
visualization of the needle tip during the initial venous puncture. After suturing
of the line, you see bright red blood spurting from one of the lumens when the
cap is removed. You realize that the line has been placed in the carotid artery
inadvertently. A vascular surgeon is immediately notified and the line is removed
and the artery is repaired. In light of the event, you decide to postpone the case.

What do you do next?

a) Write a note in the medical record about the event and allow the surgeon to
relay the event to the parents. You will call risk management later on that day.

b) Call risk management and the hospital lawyer to discuss your next step, while
the surgeon speaks with the parents about the event.

c) Call risk management, and meet the parents together with the surgeon to
explain the event and consequences to the patient, while apologizing for the error
and informing them that an investigation will be performed to determine how to
prevent such events from occurring to other patients in the future.

d) Meet the parents with the surgeon and explain the event and consequences to
the patient. Avoid apologizing or taking blame for the unintended event as this
may be used against you in a lawsuit. After the discussion, call risk management
and inform them of the situation.

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==Answer==
Answer c.

It is in the best interest of all parties involved that the parents of the
child receive full disclosure of the event. The physician responsible (not the
surgeon or other surrogate) should do their best to disclose the reason for the
error and apologize for the unintended outcome, as studies have shown that this
increases satisfaction and decreases likelihood of litigation. Notification of
hospital risk management/legal office is also important and should ideally occur
before the family meeting or as soon as possible afterwards.
==Notes==
<references />

:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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WikiSysop: 1 revision imported

metawikimedia>DrBobGreenberg at 20:16, 8 July 2015