Chapter 327: Tying Knots

Qian, the director of the ICU, pushed the door open nervously to report the situation.

"Director Bai, the patient is having problems."

"Speak," Director Bai said, concise and to the point.

"The patient just developed refractory hypotension. The vasopressors I gave had no effect, and I am currently administering fluid resuscitation."

"What about the drainage?"

"The drainage is fine. I administered Norepinephrine."

Director Bai stood up, put on a sterile cap and mask, and went to the ICU with Qian.

Under the effect of the Norepinephrine, the patient's blood pressure began to rise. Director Bai did not blame Qian; he stood at the head of the bed with his hands behind his back, watching carefully.

The situation was not as stable as before. While the patient's blood pressure had indeed returned under the effect of the Norepinephrine, it did not stop at a normal value or slightly above normal.

The blood pressure was like a roller coaster; the systolic pressure rose from 70 mmHg to 80, then to 90, 100, 130, 150, and finally settled around 183 mmHg.

"There is a problem with the waveform of the Swan-Ganz catheter."

The directors of the Circulatory Internal Medicine Department and the Cardiac Surgery department both noticed this, and they reminded everyone in unison.

Seeing that Director Bai was not speaking, Qian began to busy himself.

First, he stopped the Norepinephrine. Qian discussed the situation with Zhang, the director of Cardiac Surgery, and the director of the Circulatory Internal Medicine Department for a few minutes, then reported to Director Bai, "Director Bai, the Swan-Ganz catheter may have lost its function. I suggest removing it."

"Remove it," Director Bai said, stepping aside without interfering with the clinical work.

Zhang, the director of Cardiac Surgery, began to insert a Subclavian Vein Catheter and attempted to withdraw the Swan-Ganz catheter.

However, just as the last section was about to be pulled out, Zhang felt slight resistance. That force was very small, so small that it seemed a little extra effort would pull the catheter out.

But he was very careful and did not use brute force to pull out the Swan-Ganz catheter.

The biggest taboo for patients during and after various surgeries is the use of brute force, because one cannot see into the human heart; no one knows what is happening inside.

Zhang called for someone to bring over a bedside X-ray machine to see what was going on with the Swan-Ganz catheter.

The Swan-Ganz balloon-tipped catheter is a tool for measuring Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure, and it is essential for heart surgery.

It was inserted during the surgery for measurement, but the waveform shown by the floating catheter was wrong; no matter how one looked at it, there was a problem with the Swan-Ganz catheter.

After the X-ray was taken, a doctor from the ICU took the film cassette to the Radiology Department to develop the film.

Ten minutes later, Director Bai and the others saw the image on the computer.

The moment they saw the image, everyone was stunned and bewildered.

The head of the Swan-Ganz catheter had tied itself into a knot... just like the first knot when tying shoelaces.

Damn it!

Director Bai cursed to himself.

What kind of mess is this! How could such a bizarre thing happen during a perfectly fine heart transplant surgery!

Tying a knot—the Swan-Ganz catheter enters from the internal jugular vein, passes through the superior vena cava to the right atrium, right ventricle, and pulmonary artery.

During the removal process, for some reason, the Swan-Ganz catheter had tied itself into a knot. The floating catheter, which should have been simple to remove, could not be taken out because of a knot.

The knot wasn't pulled tight yet because Zhang had been very careful and hadn't used brute force. But what if it wasn't pulled tight? The shape had already formed, and no method would work.

After seeing the film, all the members of the Expert Group present were silent.

The incident happened suddenly, and everyone present was a bit dazed. The surgery had gone smoothly, but the problem had appeared post-operatively, in the form of a dead knot.

The Swan-Ganz catheter is knotted; what should be done next?

For a newly transplanted heart, no one had expected such a thorny issue to arise.

The experts in the Expert Group wanted to curse, especially Zhang, the director of Cardiac Surgery, whose face was flushed with frustration.

Swan-Ganz catheters are expensive, and not many patients can use them, but the Cardiac Surgery department still uses them frequently. Zhang had seen many patients use Swan-Ganz catheters, but he had never seen a case where one tied itself into a knot.

Cursing wouldn't solve the problem; the question was what to do next.

The experts from Cardiac Surgery, Circulatory Internal Medicine, and Intensive Care all fell silent, and even Lu Gang, who was usually arrogant, stopped talking.

No one had ever seen such a situation, and no one knew how to handle it.

Director Bai began making phone calls to bring in the relevant directors and experts from the Vascular Surgery department and other departments for a consultation.

Arriving with them was Zhao Yuanzhang Jixiang.

They first understood the patient's condition, and later, under the guidance of the director of the Ultrasound Room using a Two-dimensional Color Doppler Ultrasound, they removed the Subclavian Vein Catheter.

By this step, the patient's vital signs were stable, with no other complications.

Then came the question of how to remove the Swan-Ganz catheter.

"Can the Vascular Surgery department open the jugular vein?" Director Bai asked.

"It's very difficult," Director Wang of the Vascular Surgery department said without hesitation. "If we pull it out further, the knotted part will become tighter. The diameter is quite thick, and it's hard to guarantee we won't hit something while passing through the jugular vein."

He spoke in general terms, but those present understood.

The neck is dense with blood vessels and nerves; having such a thick knot traveling through the jugular vein, it would be all too easy to hit some nerve sensor and cause sudden cardiac arrest or something similar.

"Zhao Yuanzhang, what do you think?" Director Bai asked with a frown.

"Listen to the experts' opinions," Zhao Yuanzhang said, beginning to play tai chi.

He himself came from a clinical background, but he was an orthopedist. When it came to a procedure like a heart transplant, it was unlikely that Zhao Jixiang could offer constructive advice.

Director Bai was only following protocol and asking for Zhao Yuanzhang's opinion out of respect.

"Where is Zhao Xiangming? Why hasn't he arrived yet!" Director Bai asked with a frown.

"It's the weekend; Director Zhao must have gone fishing," Qian, the ICU director, said helplessly, knowing Zhao Xiangming's habits and hobbies. "And Director Bai, if I may be blunt, it wouldn't be useful even if Zhao Xiangming came."

"We have to try."

The knotted position of the Swan-Ganz catheter is inside a blood vessel; for this kind of operation, the weight of the Interventional Department is sufficient.

After a full half-hour, Zhao Xiangming arrived, panting for breath.

"Zhao Yuanzhang, Director Bai, I'm sorry, the place I went fishing today was a bit far," Zhao Xiangming apologized as soon as he arrived.

"Look at the situation, do you think it can be removed?" Bai Chuzhang did not scold anyone, but asked directly.

Zhao Xiangming took a look at the imaging data and shook his head like a rattle-drum.

"Impossible, absolutely impossible," Zhao Xiangming said, "Although the position is relatively shallow, to untie the knot here, one would need to use a Guide Wire to go in and push the tip of the Swan-Ganz Catheter out."

"With the influence of blood flow, trying to solve the problem point-to-point, such a possibility basically does not exist."

Zhao Xiangming spoke very bluntly and very resolutely.

"Sigh."

Someone sighed deeply, though it was unclear who.

A Swan-Ganz floating catheter Tying Knots inside the body—such an absurd thing had never even been heard of! Yet this rare situation had actually been encountered; using Interventional Surgery definitely wouldn't work, so what was to be done next?

"Really impossible?" Bai Chuzhang stared at Zhao Xiangming.

"..." Zhao Xiangming was speechless; he hesitated for a moment, "Bai Chuzhang, I'll make a phone call."

(End of this chapter)