Shunt this, all you naysayers

October 5, 2009 at 8:24 pm | Posted in Uncategorized | 2 Comments

Yesterday I put in my first solo EVD.  I know, I know, it’s freaking October, and this is my first?  WTF?

My sentiments exactly.

What’s been happening is that every time a patient needs one, there’s some reason or another why it’s not a good opportunity for me to do it under supervision.  Or the person who’s supposed to supervise me, instead just does the whole thing themselves while I stand there watching.  In addition, this particular program is beta-testing a super-fancy new intracranial monitoring device that’s significantly more complicated to place than an EVD.  And because we’re mostly using this other device, there aren’t many plain old EVDs to place, here.  And no one, including me, thinks it’s appropriate to do the advanced procedure without any practice at the basic one.

It’s been very frustrating getting procedural experience with EVDs, and not just here.  When I was an intern on neurosurgery, there was always an R2 who still needed to learn, so all I ever got to do was observe.  I can’t tell you how many times I was told “you can do the next one,” and then the next one comes in, and there’s some new excuse for why it’s still not mine to do.  So I’ve watched close to thirty of them at this point, and of those thirty, I’ve marked out and made the incision once, drilled the hole twice, and passed the catheter twice.

I figure I’ve been supervised at least once doing all the major components of the procedure.  So last night I was on call, and a patient came in who clearly needed an EVD, and my chief  concurred.  He asked if I needed supervision, and I told him I felt pretty comfortable that I knew the procedure, and had been supervised doing each component of it, although not all at once.  (I may have exaggerated my comfort level: mostly I was just sick and tired of always having it taken from me, when I knew I was perfectly capable.)  So he told me to go ahead and do it, and call him if I ran into any problems.

So I did it.  The result?

One pass.  Perfect position.