One of the many things I got to be a part of was a PDA ligation on a neonate.
What is it:
The ductus arteriosus is a temporary fetal blood vessel that connects the aorta and the pulmonary artery before birth. The ductus arteriosus should be present and open before birth while the fetus is developing in the uterus. Since oxygen and nutrients are received from the placenta and the umbilical cord instead of the lungs, the ductus arteriosus acts as a "short cut" that allows blood to bypass the deflated lungs and go straight out to the body. After birth, when the lungs are needed to add oxygen to the blood, the ductus arteriosus normally closes.
However, when it does not close, a PDA ligation is needed.
How to diagnose PDA:
Diagnosis is most often made by detecting a heart murmur heard through your stethoscope. Tests such as a chest x ray,and ECG determine the severity of the PDA.
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When I found out I was going to get to go in on the ligation I was waiting on it all day! It's kind of like when you were a kid on Christmas Day waiting and waiting....and waiting... for mom and dad to say you could open gifts. It was like Christmas for me! But when you're waiting on the one and only neonatal cardiology surgeon in town, you're on his time.
I compare the RT department here to a fishbowl because it is surrounded by windows so that if you go into the department you are still able to see babies and their vitals.
Anyway. I was sitting in the fishbowl reading (I may or may not have been starting to nod off because all the lights are dim in the NICU)when I thought I overheard someone say "PDA" my head popped up and I looked around to see if anyone else heard it or if I was just dreaming. I figured if they did they would start walking over to that neonate. Because, after all, who HASN'T been waiting on this all day?! Nobody acted like something freaking cool was about to happen, but I walked out there anyway. And guess what! It was time!!!!!! I saw the nurse starting to scrub up to prep the patient. YYEEEEEEEES! I went and got the RT I was following because I was too scared to be in there without him in case something happened. I didn't want to shit my pretty greys anatomy scrub pants(shutup).
We scrubed up: gown, gloves, chef hat, mask. This is now a sterile area. No more fun and games.
People in the room: a few scrub tech people, anesthesiologist and his carts with goodies, RN, me and my RT, and the surgical cardiologist.
The baby gets turned to his side and secured in a comfortable position. Everything gets draped with blue sheets. *Anything blue is sterile. Don't touch it. The ceiling and windows will crash in, fighter jets will land right beside you and you will be taken hostage due to your ignorance*
The anestheologist gives his meds so the baby is comfortable and doesn't feel any pain.
Surgeon marks the spots on the babies skin with a marker.
Someone cleans and sterilizes exposed baby skin. Then it starts.
The area is cut open and the surgeon does his magic and uses the worlds smallest stapler to close the PDA. Then sews up the opening.
The whole time this is happening we are monitoring the patients vitals. If his sats start to drop or if his heart rate or blood pressure get out of normal limits we are perfectly positioned at the starting line to take off and do OUR thing. The babys sats do drop into the 70s and the bp raises. We change some settings on the vent and continue to monitor.
Everything slowly normals out.
Doc calls for chest xray.
Nurse tells another nurse (who is not scrubed up) to call radiology for cxr stat.
Surg techs start to pack up their stuff to go.
Radiology comes, I leave so I don't get nuked.
Film comes back. We look and you can see the little metal staple.
There was a very small pneumo on cxr. If the pneumo is large enough, a chest tube will need to be placed during the pda ligation. But we didn't have to do that this time.
Yes it WAS freaking awesome and I left with clean scrubs.
Some pictures I found for you:
7 comments:
Hey stranger!
Very interesting post, very interesting disorder. I concur.
I was watching a show on the Discovery Channel the other day (maybe Mystery Diagnosis) about a woman who was around 40 years old and had chronic debilitating migraines of an unknown origin. They found out that her ductus arteriosis had never fully closed at birth and this constricted blood flow, causing migraines.
Yeah I saw that too! Pretty interesting stuff.
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