TYK110

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

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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