innominate vein. The right internal jugular vein is patent. Acute
Since then, things have just been going 100MPH. Yesterday they started addressing the clots found above. I was set for emergency surgery. The wait was insane. I fucking hate the wait. It’s always the hurry up and wait scenario.
As I sat and waited, it was hard texting everyone what was going on. Honestly I am tired of always texting my close friends and family that “Something else is going on”. It just feels like its just an annoyance at this point. It saddens me that this is the burden I am on those around me. This sucks.
As the hours went by, my anxiety was just incrementally going up as time kept going and going. It was hard to fall asleep, i didn’t want to miss the call for surgery. Finally, its time. But with a twist. As I sat in my room, getting all my shit put together, I was told that I wouldn’t be returning to the room I literally was waiting over 12 hours for. It hasn’t dawned on me how serious this really is. Thats when as I was being transported down to my procedure, I started to read that report.
Echoing in my head over and over. Like, this is really fucking serious. The clot is between my right elbow, and trasverses the ENTIRE way up my right arm, crossing over to my subclavian/proximal veins. To put that in perspective:
As you can see, we are getting danger close to my heart. The clot was pushed up that far. Un-fucking real. I kept this detail to myself. I didn’t want to scare anyone. But as you can see, this has gotten super serious. As I write this, the internet here just fucking sucks. Super duper slow. Aggravating to no end….
It’s so slow, I keep dozing off LOL. As I sat in the prep area, I spoke with the staff, they reassured me everything was going to be ok. At this point, I started telling my wife the seriousness of what was about to happen. Why sugar coat it any longer…
003653185 TRANSCATH INFUSION VEN INIT RIGHT ARM VENOGRAM AND INITIATION OF THROMBOLYSIS
PROCEDURES:
1. ULTRASOUND-GUIDED ACCESS OF THE RIGHT BASILIC VEIN
2. INTRODUCTION OF CATHETERS IN SUPERIOR VENA CAVA
3. RIGHT ARM VENOGRAM
4. PLACEMENT OF AN INFUSION CATHETER AND INITIATION OF THROMBOLYTIC
THERAPY
EXAM DATE AND TIME: 11/17/2020 17:55
INDICATION/DIAGNOSIS: Extensive right upper extremity DVT. Previous
left upper extremity DVT in left lower extremity DVT. Combined
immunodeficiency syndrome. Patient takes IVIG monthly.
CONTRAST: 45 mL Isovue 300
SEDATION: Moderate sedation was administered by a trained independent
observer under my direct supervision. The independent observer
provided constant monitoring of the patient and was present, with me,
through the entire procedure. Total sedation time: __30 minutes
TECHNIQUE: Informed consent was obtained. The procedure was performed
using maximal sterile barrier technique including cap, mask, sterile
gown, sterile gloves, large sterile sheet, hand hygiene, and 2%
chlorhexidine scrub for cutaneous antisepsis. The right arm was
prepped and draped in sterile fashion. Lidocaine local anesthesia was
infiltrated around the right basilic vein.
Local anesthesia was obtained 1% lidocaine. Right basilic vein was
partially thrombosed by ultrasound just above the elbow but in an area
that had less inflammation than the rest of the arm. Ultrasound image
was obtained and stored in the patient’s PACS medical record.
Micropuncture needle was advanced into the basilic vein. Guidewire was
advanced centrally. 4 French catheter was placed. Right arm venogram
was performed. Contrast was injected both into the basilic vein. In
addition catheter was advanced over into the brachial vein were brachial
venography was performed.
Catheter was then advanced from the basilic vein to the axillary vein
and into the subclavian vein. Subclavian venography was performed.
Catheter was then advanced to the SVC where venography was again
performed. Short 6 French sheath was placed.
A 6 french EKOS infusion catheter with a 24 cm working length was then
advanced extending from the superior vena cava without to the basilic
vein. Thrombolytic therapy was initiated at 0.2 mg per hour with
heparin running at 900 units per hour. Patient was transported to the
PACU in good condition and tolerated the entire procedure well.
FINDINGS: Superior vena cava is without clot.
There is mild narrowing at the central subclavian vein but the
catheter course through this area easily. Acute clot is seen in the
subclavian vein, axillary vein.
Nonocclusive clot is seen in the brachial vein. Occlusive clot is seen
in the mid basilic vein.
Multiple collaterals are seen coursing up to the region of the
internal jugular vein.
FLUOROSCOPY METRICS: Air kerma: 13.6 mGy or Time: N/A and Images:
N/A.
ESTIMATED BLOOD LOSS: Less than 10 mL.
SPECIMENS: None
COMPLICATIONS: None
IMPRESSION:
1. Acute appearing clot in the subclavian, axillary, and brachial
vein.
2. Mild narrowing of the subclavian vein at the crossing first rib.
3. Initiation of thrombolytic therapy.
Man what a whirlwind in 24 hours. This is where we are from yesterday. I am exhausted. I do have to admit that having that stent installed in me was the most uncomfortable thing that I have ever experienced.
But I think I need to stop, and talk about the care I have received here. From the ER, to the surgical team(s), and to the people in the ICU. The only thing that sticks out, are two night/day differences… literally, and figuratively. Kadie. Where to begin… probably the most humane, down to earth, and caring person I have ever met. Her patience, is unparalleled. The day after the stent was installed, was, well you guessed it… infusion day. The day nurse (don’t care to remember her name) I had after Kadie was the polar opposite. She was bumbling, rude, unable to accept the fact that she cannot take any criticism. She was crass, and very intolerant to patient input. I get it, I’m in the ICU… typically those people in the ICU are not as alert/awake/attentive as I am, however, it started off with shift change.
Why don’t I remember her name? Didn’t even introduce herself, so we are already off to a great start. As the shift changed, and Kadie left for the night/day :,,( whats when nurse “B” started to show her real colors as far as patient care, bedside manner, and just everything in general. At shift change, my dilaudid was due. She ended up shooting a pretty good portion of my dose against the wall…. And when I pointed it out to her, and how upsetting it was to hear her piss-poor excuse of “You still get some” was just jaw dropping. After that happened she started using a short attitude, and attempted to flush an IV that has been giving me problems. Of course it was done… it stopped working.. blown.. whatever you want to classify this as. But when I brought up the fact that it should be removed as its starting to hurt, her face was replaced with the on-shift doctor, and she disappeared… quickly.
I then turned to him and straight up said that I refuse her care. I mean it wasn’t even 15 minutes, and I witnessed so many fuckups, followed up with probably the worst attitude ever, I said “I honestly don’t want her near me.” The doctor finally understood what I was talking about, and told me that this always a “problem”. Oh fucking great. I get “that” nurse.
When she returned, I informed her that I will need to do my SCIg infusion and that she will need to help with preparing my treatment. Oh you already know where this is going. I have never heard more stupid excuses come out anyones mouth. Excuses ranging from “I’m not allowed to, to I have never done that”. I’m just shocked and appalled by this nurses behavior at this point. Can’t ask her to do anything. Can’t put on the call light in the event that she actually has to get up off her ass and do something. Shes used to potato patients that don’t have a voice, or are unable to advocate for their health.
I gently tried explaining to her that this is required, and that I would help her learn no problem that way she would have this knowledge for next time. What normal person would say no to that? Yep. More I don’t give a fuck attitude. At this point I told her that I want the IV removed from my hand and replaced so that I have two working IV’s in the event they need to do more medications, or treatments that can be done in parallel. Again, excuses and a “I’m not going to do this” stance.
All day she avoided it. Taking my pump out of the room saying she needs to “check it in”, or take my immuglobulin for “inventory” purposes, I started putting my foot down. “I’m sorry that this is what I have to do on a weekly basis to survive. Since I cannot use my right arm (literally), I need someone to just simply help me draw up the medication, and help me. I can handle most of the tasks. She then started stating false times.
All day it was communicated that my next surgery was at 4pm, wrong it became 2:30pm. Right around the agreed time we said we were going to do my infusion. Just wow. Ignorant people. This is the type of care I’ve been getting the past 3 years though, so I am used to seeing this stupid shit.
My attention now moved to me getting wheeled by this same individual to surgery. Jesus what a fucking nightmare. The poor girl that was transport was getting yelled at by this nurse every 30 seconds. Between the two of them, it took them at least 15 minutes to get my bed out of the ICU room…. yeah. As we went down the hallway, either the one pushing the bed, or the one pushing the cart with my stent / clot treatment kept ramming into the wall, or a door. Then it started getting to the point where the nurse started yelling at her,
As tweedledum and tweedledee trasverse this intimate dance of pushing two things in a straight trajectory and maintaining equal speed is something these two were incapable of pulling off together. Yep. It’s that nurse just making my life miserable. Not sure if it was deliberate, but it got to the point where they came damn close to ripping out the clot treatment setup. That would have just been the icing on the cake.
As I rolled into interventional radiology, they got me on to the OR table and got me all situated. Met all the staff, and the doctor. As time went on, sounded like something that was ordered didnt show up. As the procedure started, as before, my anxiety is through the roof, atmosphere, galaxy… My body was just shaking from all the stress. Versed didn’t do much for me this time. Nor the pain meds. I literally sat in the OR for 2 1/2 hours feeling them coat hanger me. Oh yeah, the clot buster they put in, didn’t work. So they had to manually remove all the clots from my arm, shoulder, and neck.
I feel so much better now, only time will tell, but maybe… JUST MAYBE….. this is the end?
