At work the other day, I was caring for an extremely critical patient who had become septic after a bowel surgery. She had a leak and needed to go to the OR for repair. I sent the patient to the OR on levophed at 75 mcg/min, vasopressin at .04 u/min, bicarb gtt, sedation, and a fluid bolus hanging. The patient had a QLC in the right subclavian that was functioning well. During the case, the surgeons had agreed to put in a quinton for dialysis access so we could begin CRRT when the patient returned from the OR. I told this to the anesthesia provider (I will not say whether it was an MD or CRNA b/c I don't want to go there) when giving report. Well, the patient came back from the OR with her new quinton and a new DLC in the left IJ. When I asked anesthesia were my QLC had gone, she said she took it out and put in the double lumen b/c the lumens were larger and she could give more volume. When I looked at the anesthesia record, she had only given one bolus of albumin and one bag of crystalloid during the case (no blood, nothing). When I asked her where in the world I was supposed to run my pressors, sedation, bicarb gtt, calcium gluconate gtt, xigris, insulin, and multiple piggybacks, she just looked at me blankly and said, "I guess you should call the surgeons to put in a new line." Now, granted the xigris and insulin were new orders she didn't know about, but come on! Why in the world would you take out a quad lumen and replace it with a double on a critical patient? I know I am venting and this is long, but I would really like to know if there is a logical explanation or if any of you that are practicing anesthesia would do this. Yes, I did get a new quad lumen but it took over 2 1/2 hours to get someone to do it and my CRRT wasn't started until almost 6PM, even though the patient returned at 1:30.
