Description of Event or Problem · 1
PATIENT FOR ROUTINE LEFT KNEE SCAPE - AFTER PROCEDURE BEGUN PT OBSERVED TO HAVE INCREASED BLEEDING TOURNIQUET CHECKED FUNCTIONING PROPERLY. SURGEON ASKED INCREASED PRESSURE ON ARTHREX FLUID PUMP (B)(4) TO 60MM - ADVISED SURGEON HIGH PRESSURE. HE REPLIED SOMETIMES WE USE 80 MMGH PRESSURE INCREASED TO 60MMHG AS REQUESTED. PROCEDURE CONFIRMED AND FINISHED. PT'S LEG FOUND TO BE RED, SWOLLEN AND FIRM IMMEDIATELY AFTER DRAPES REMOVED. (B)(6) NOTIFIED - PUMP REMOVED FROM OPERATING ROOM. PT'S BP WAS 130 SYSTOLIC AT THE START OF THE CASE. THE TOURNIQUET WAS SET AT 275. PUMP PRESSURE WAS SET AT 30. NINE MINUTES INTO THE CASE, THE BLEEDING WAS IMPAIRING VISIBILITY SO I INSTRUCTED THE CIRCULATOR TO INCREASE THE PUMP PRESSURE TO 60. THE BLEEDING CONTINUED DESPITE INCREASE PUMP PRESSURE, WHICH IS WHEN I ASKED ANESTHESIA WHAT THE PT'S BLOOD PRESSURE WAS. IT WAS OVER 200 SYSTOLIC WHICH EXPLAINED THE BLEEDING. THE PUMP WAS TURNED DOWN TO 50, THE SURGERY WAS HALTED UNTIL THE BP WAS UNDER CONTROL. THE TOURNIQUET WAS RELEASED. WHEN VISIBILITY WAS RESTORED AND CONDITIONS WERE FAVORABLE FOR ARTHROSCOPY, THE CASE CONTINUED UNEVENTFULLY (MINIMAL DELAY 2-3 MINS). AT THE END OF THE CASE IT WAS NOTED THAT FLUID EXTRAVASATED INTO THE THIGH OF THE PT. HE WAS N/V INTACT IN THE RECOVERY ROOM AND WAS RELEASED UNEVENTFULLY TO HOME. HE WAS SEEN THE NEXT DAY, THE EXTRAVASATION HAD COMPLETELY RESOLVED, AND HE WAS DOING WELL. (B)(6).