Thread by @critconcepts

(Inspired by recent talk)
Skilled proceduralists are often asked to help other providers/teams, such as placing a tough line. Here are some important points for this. It is NOT the same as doing procedures on your own patients. (🧵):

#medtwitter #FOAMcc #FOAMed #pulmcrit

1. You are asked to "help," usually verbally, but you're still responsible for your own care. So this is actually a consultation of sorts. Does the patient actually need what they thought? Usually they know their problem ("we need access") but not always the best answer.

They also may not be aware of all relevant contraindications or technical obstacles... or they may simply not care. In other words, they're expecting YOU to consider these. If you do something dumb, you can't just say "well, someone told me to do it."

So inspect the chart and read over the patient's history. Note their med/surgical history. Consider glancing at imaging to be aware of the status of their vessels and presence other hardware.

Note their labs (coags, platelets, renal function, etc), meds (how many infusions? do they need to be central or no?), and overall plan (how long will the patient be here? are other measures planned, such as a a PICC, dialysis, etc?)

2. What about consent? It is a common courtesy for the primary team to handle this, but that may not be possible or even appropriate if they are not trained to do the procedure. While a bit annoying, expect you may need to do it yourself.

3. Ask how urgent it is to plan your own day. If not urgent, i.e. you were asked to help with something a while ago, when you're ready, check at the last minute if it's still needed. Things change; someone else may have done it, the plan shifted, the patient is CMO now, etc.

4. Follow up, at least to some extent. This is not your patient, but you should know about complications of your procedure, how successful it was, etc. Even if the primary team does so too, always confirm your own line, look at the x-ray, see how dialysis is flowing, etc.

5. Be gracious. These requests can be annoying, but ultimately someone's asking for your help because they need it and you can provide it, not to ruin your day. "Will it help the patient?" and "Is it the best solution?" should be your only questions.

(Secret caveat: more broadly, Kant's Categorical Imperative may apply, e.g. even if it helps this patient, does it set broader harmful precedents? E.g. if I start placing IVs on the floor, is that going to become my full-time job? But try not to let this dominate your thoughts.)

Bonus points: I also try not to do this unless discussed with the primary team (versus, say, scuttlebutt via the nurses)... and I try to write (e.g. in the procedure note) who asked me to do it and why. Otherwise there may be no documentation why you laid hands on this patient.