Tempus Fugit

Time Flies…

   Oct 15

The Interpretative Bronchoscopy Dance

I’ve been in this job now three days and I’m amazed at how many things get poked into how many holes – and how many holes get made by poking sharp things in to get to places that aren’t accessible by natural holes.

I put in my first central line this week. There is something slightly disturbing about sticking a very sharp and very long thing into someone’s neck (albeit with an ultrasound and some anatomical landmarks to help)….trying to find the jugular vein whilst avoiding other somewhat slightly important structures (say for example the carotid artery). Not only that, once said vein is located, the next step is to feed a somewhat long wire downwards….towards the heart before feeding an even bigger tube over the wire (whilst holding on to the wire at all times ———allegedly there’s several wires that need to be retrieved each year in this state alone because somebody forgot to hold onto the wire).

I was successful in my first central line placement. **golf claps**

I was going to also insert a VasCath (that would be a vascular catheter) into someone also to allow them to be dialysed. Fortunately or unfortunately the patient turned out to be coagulopathic (which for the layperson means they could easily bleed like a stuck pig). The consultant had the honour of inserting the aforementioned catheter – with a diameter only slightly smaller than a garden hose into the groin of the renally compromised patient.

Perhaps the most intriguing thing I did this week was a bronchoscopy. Bronchoscopy is the art of feeding a fibre optic cable down into the lungs of a patient and among other things sucking out mucus. This seems fairly straightforward in theory until I was informed that there are a number of areas of the lung to be visited (a road map was drawn for me). To make things a little more challenging, the control of the direction of the bronchoscope is controlled in one dimension by a joystick kind of device but for the other dimensions you actually have to physically twist your entire body around an axis in order to safely rotate the fibre optic cable. This has the appearance of an interpretive dance – the operator has an eye attached to the bronch’ and is hunched over the patient’s head with the cable feeding down the tube into the patients lung. As the operator navigates and traverses the various segments of the bronchial tree (and seriously down there you just about need a GPS), they can be seen writhing and twisting in a hypnotic manner in order to align the scope in the right direction.

… an art that I am yet to muster. I think these devices should come with driving lessons. Luckily after I managed to view a few of the lung segments, the consultant was on hand to locate the other segments and aspirate a creme-brulee-like substance from the lungs. Mmmm tasty.

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