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

LadyFree28, BSN, LPN, RN · Mar 10, 2015

Care of a 600 lb woman with two colostomies and had to setup a drainage system using a Foley catheter;

Helped delivered a macro baby

Performed a wound packing next to a trach stoma on a pt with throat CA and was able to do the trach change.

No sweat.

I will say that this was the most complex: care of an infant with a omphalocele and perform the dressing change.

nurseprnRN, BSN, RN · Mar 10, 2015

Quote from klone
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.

An acquaintance just had this. Baby was almost crowning but face-up and she was pooped out from long labor and the baby was just not moving. They whipped her in for a section-- and she has a HUGE incision, almost from iliac crest to iliac crest (she is a big woman, over 6 feet tall), no bikini line little smile for her. Baby is apparently fine last I heard, but she was not out of the hospital for days and days.

2k15NurseExtern4u, BSN, RN · Mar 10, 2015

I lovveee this thread! Hopefully it turns out to be one of those threads that last for 15 years. Lol

Julius Seizure · Mar 11, 2015

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

After listing all that crazy stuff, you top it off with a little thing like a scalp IV????!

blondy2061h, MSN, RN · Mar 11, 2015

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.

They did one of these when I was shadowing in OB years ago in nursing school. I didn't realize it was do unusual. Everyone was so calm and the procedure was quick.

jifferte, BSN, MSN, RN · Mar 11, 2015

Hmmmm.... Good post. Let me think..... Midline placements, declotting occluded PICCs at the pt's home with cath- Flo. Obscenely complicated wound dressing changes, wound vacs, chest tubes, full Trach changes, adjusting ventilator settings...

But, in nursing school the anesthesiologist had me intubate. I think that probably ranks up there.

BSNbeauty, BSN, RN · Mar 11, 2015

Cracking open a chest at the bedside. Not performed by me obviously but being there and assisting the intensavists. Scary !!!!!!!

Julius Seizure · Mar 11, 2015

Cracking open a chest at the bedside. Not performed by me obviously but being there and assisting the intensavists. Scary !!!!!!!

Are you in peds or adults? We do this in pediatrics, and yea I would say that when its just you and a surgeon in the room with an open chest...its a little intense.

klone, MSN, RN · Mar 12, 2015

Cracking open a chest at the bedside. Not performed by me obviously but being there and assisting the intensavists. Scary !!!!!!!

Explain to the OB nurse - in what situation would you do such a thing?

PMFB-RN, RN · Mar 12, 2015

Probably opening the chest covering and suctioning the blood that was causing a taponade on an open heart patient who was brought to the SICU with his chest still open. The CV surgeon had sat in the SICU and done it 3 times with me and another nurse assisting. He had already told the family the patient had a 15% chance ofliving. The surgeon described the ventricle wall as being "like yogurt" to me. Finally at about 2AM the CV surgeon said, "I have toget some sleep. If he tamponades again just do what you saw me do, and don't knock any of my graphs loose".

I was like "who me?". He assured me that I could do it as I had already helped him do it 3 times. We did do it. Twice that night and again the next night. Patient didn't make it.

Or maybe doing an RSI on a farmer in a freezing cow barn while kneeling in 4 inches of liquid cow manure with a terrified deputy sheriff holding a flashlight and a local teacher / volunteer EMT holding cric pressure. The farmer had a 1500# dead Holstein bull laying across his legs where it landed after the farmer's son shot it while it was attacking the farmer. It was 7 below zero and snowing so hard the helicopter was grounded. We were supposed to meet local EMS enrout but we just kept going and never met them until we got to the scene. They finally got a long chain from the neighboring farm and hooked one end to the bull and the other out to a tractor and pulled it off of him,when of course his BP immediately dropped, we (the paramedic & I) had two IO's going, one in each proximal humerus. Once with PRBCs and one with NS and Neo. We stabilized his fractures, loaded him on the rig and an hour and a half later got him to the trauma bay. He made it.

The other crews never stopped complaining of the smell in the rig after that, even though we thoroughly cleaned it and there wasn't really a smell after that.

PMFB-RN, RN · Mar 12, 2015

Explain to the OB nurse - in what situation would you do such a thing?

Not a terrably unusualy event in an SICU or CV ICU. Usually in cases where a new graft (in CABG patients) breaks loose and the patient is bleeding like crazy. Have also seen it done for tamponade and for aortic anurism that broke loose. Most SICUs and CV ICU actually have a stocked cart on the unit to be used in such situation. In one of my previous jobs we did it weekely it seemed as we had a huge open heart program and did a lot of emergency hearts (not first worked up by cardiology)

PMFB-RN, RN · Mar 12, 2015

Cracking open a chest at the bedside. Not performed by me obviously but being there and assisting the intensavists. Scary !!!!!!!

Remember PMFB's first rule of crashing patients and codes;

1) It's not _ME_ so everybody calm down.

Good job!