Let me start this stating that I am a new grad. I have been a circ for about a month and a half.
It was brought to my attention that one of our surgeons has been injecting 1% lido w epi into the neck for his ACDFs without aspirating the syringe. The person who commented was the CRNA.
We draw up a max of 10cc per syringe for him. Each stick he gives a max of 2cc. He palpates the neck once before starting the injection. He doesn't palpate between sticks. I agree with the CRNA that he is too close to the carotid to not be aspirating. But of course the plot thickens...
This surgeon is our humble little hospital's money maker. He is also the grumpy sort that gets "uppity" nurses canned. So if I call him out, I've got to be completely sure that I'm right. He wouldn't be happy about getting corrected by a new nurse. Personally I don't give a hoot how he feels about me if I'm doing the right thing for my patient.
So should he be aspirating when giving these locals? Is this a grey area? I honestly don't know what 1-2cc of 1% would do to a healthy heart. Would that amount cause rhythm issues in a normal adult? Is this a battle I need to fight?
Jul 12, '12
Just ask the CRNA what to do. They're never wrong!
Jul 14, '12
One way is just ask the surgeon why he doesn't aspirate when he injects. But do it in a way that comes across is if you are trying to increase your knowledge. He might have a good reason why he is doing it that either the CRNA or you do not know about. The CRNA should diffently speak with his superiors about this because if something does go wrong it will be his hide along with the surgeons. You should also speak with your NM about this because others might have brought this up in the past and it already has been addressed.
Jul 15, '12
I agree, ask him as a learning experience, a large artery would flash and pulse blood back into the syringe, besides, it's tough and you can feel it with the syringe/needle, you can also feel veins as well...is he injecting and advancing or withdrawing? He did find his landmarks, odds are he knows exactly what he,s doing, that amount of Lido wouldn't affect the heart at all....but in the artery first stop would be the brain. Practice isn't always by the book, after years of doing a procedure..you developed your own style...also, has he ever injured anyone? Do not get drawn into a battle with this guy - you're right-others have fallen for doing so. Just ask-nicely without foredrawn accusation...say I'm just learning and wondered why ...
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