Becton, Dickinson and Company · NYSE:BDX
Becton, Dickinson and — Technical Presentation (April 2020)
8 slides from Becton, Dickinson and's technical presentation, April 2020
Slide 1: Presenter views disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: When Vascular Access Doesn't go to Plan
When Vascular Access Doesn’t go to Plan Dr Tim Jackson Consultant Anaesthetist Calderdale & Huddersfield NHS Foundation Trust
Slide 3: Outline of the case
Outline of the case • 77year old female • Inpatient for many months • Original colonic resection, slow recovery • Developed ischaemic leg – required bypass surgery • Frail, COPD, heart failure, intermittently confused • Referred for CVC to permit TPN • Pleasant lady, readily agreeable to CVC placeme
Slide 4: What would you do?
What would you do? • Proceed with insertion as requested? • Decline/defer to someone else? • Insert a different VAD (eg: PICC?)
Slide 5: CVC insertion
CVC insertion • Verbal consent • Patient breathless while lying flat • Standard technique • US guided – axillary SCV • Valsalva to make vein more prominent • Well tolerated, no apparent complications • I then went on holiday for 2 weeks!
Slide 6: On my return....
On my return.... • Can I have a word, Dr Jackson” • Patient had deteriorated during the night • Died • Autopsy – 1.5l haemothorax on same side as line inserted • Clot adherent to brachiocephalic vein • Cause of death : haemothorax
Slide 7: How would you feel now?
How would you feel now? • I killed this poor lady • She was high risk, these things happen • The procedure was fine, there must be another explanation • I’m never doing this kind of thing again!! • All of the above!!!!
Slide 8: Outcome – Coroner's Inquest
Outcome – Coroner’s Inquest • Long & drawn out case • Family very unhappy about a lot of things, but not the insertion • Being the local ‘expert’ protected me from any criticism • Aftercare was heavily criticised • Probable cause – dilator stretched fragile vein into tearing • Only change in my prac
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