What is the most complex clinical procedure you had to do in your career?

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As a student in her final year, the most complex clinical procedure for me has to be cleaning and packing a wound. I did this numerous times during clinical. What about you?

Specializes in Long Term Acute Care, TCU.

Wound- Absolutely zero abdomen. No Muscle, no fascia, no omentum, just organs that needed to be delicately packed around. To make it worse, the patient had a hole in their stomach that continuously leaked the powerade that they drank all day long.

Then there was the exposed (12 inches) of vertebrae.

There was also a backside wound on a 500 lb man. Eight Kerlix and 10 ABDs.

Trachs are nothing. Once had a floating jackson inside a three-inch diameter site that had to be packed around. Needed three people to turn the patient as one had to hold the trach the whole time.

Hate PEG placements at bedside. So very brutal.

How about pushing a prolapsed rectum back up inside someone?

Then there was the 600 lb woman with a recessed urethra.

Got a million of them.

How about the first time you put an IV into a scalp vein?

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Specializes in psychiatric.
RN delivery of a macrosomic infant with a 2-minute shoulder.

English please for the psych nurse?

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Specializes in Family Practice.

Exchange transfusion it is very detailed and I am so glad we do not have to do these on a regular basis.

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Specializes in Nurse Leader specializing in Labor & Delivery.
English please for the psych nurse?

Big fat baby (seriously, I think the baby was about 12 lbs and the mom was 4'11"), 2am delivery and doctor was on his way, but not yet at the hospital when the baby came out, and the baby's head came out and the rest of the body got stuck for about 2 minutes. Probably the scariest moment in my career.

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Specializes in Complex pedi to LTC/SA & now a manager.
English please for the psych nurse?

Macrosomic = very big baby over 9lbs high risk for hypoglycemia. 2 minute shoulder = baby stuck in birth canal at shoulders (too wide to fit out. Sometimes doctor must dislocate one or both shoulders if episiotomy is not enough to deliver. Head is out so too late for c/s) for 2 min. Risks of complications very high

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Open sternal wound post heart transplant, fungal infection. Not only big, complex, and scary, but so very sad. Eventually it ate through the aorta and that was that, a life gone in a flood over the side of the bed.

Critical care transport of person who cooked all his clotting proteins with hyperthermia while fighting a fire. No burns, just no clotting factors from a temp of 109•F. Bleeding from everywhere in the air ambulance (and I mean everywhere-- eyes, mouth, the teeny cut on his chin from shaving that morning, GI, lungs....) and ran out of pressors just as we screamed into the ER after surface transport from the airport. I had called ahead so the last drops, literally the LAST drops were falling into the drip chamber when the ER nurse ran out in the ambulance bay and threw me a new bag. THAT close.

Last one, a sweet man with a horrible heart who was not eligible for a transplant and all we could do was give him industrial strength IV antiarrhythmics and defibrillate him all the time. I mean, all the time. They would send orientees into my room to sit with me so they could all have their turns at hitting him with the paddles. Two or three times a shift, and he would wake up and cry and I would cry and we'd just wait for the next time.

After five days of this he died in the ambulance going back to his home hospital when the antiarrhythmic ran out and the EMS didn't notice soon enough. We TOLD them to be careful...

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Specializes in Critical Care, Emergency Medicine, C-NPT, FP-C.

Pericardiocetesis and tube thoracostomy in a traumatic arrest. When working in a clinical environment, however, it was an RSI of an asthmatic.

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Specializes in Community, OB, Nursery.
RN delivery of a macrosomic infant with a 2-minute shoulder.

I think I crapped my pants just now.

That is scary as hell.

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Specializes in Nurse Leader specializing in Labor & Delivery.
Head is out so too late for c/s) for 2 min. Risks of complications very high

Actually, there is a procedure called Zavanelli (sp?) which is a last ditch effort - basically you push the baby's head back in and take mom back for a crash c/s.

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Specializes in Community, OB, Nursery.
Actually, there is a procedure called Zavanelli (sp?) which is a last ditch effort - basically you push the baby's head back in and take mom back for a crash c/s.

I have heard of Zavanelli being done, but never heard of it ending in a good outcome.

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Specializes in Long Term Acute Care, TCU.
Actually, there is a procedure called Zavanelli (sp?) which is a last ditch effort - basically you push the baby's head back in and take mom back for a crash c/s.

Didn't they use that move in a Monty Python show?

Or maybe it was the movie Dirty Dancing

"Nobody shoves BABY back up there...."

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Specializes in Long Term Acute Care, TCU.
Macrosomic = very big baby over 9lbs high risk for hypoglycemia.

New word coined by me:

Macroimpaction- a lodged amount of feces at high risk for "up to the wrist" insertion

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