Start From Emergency Doctor

Chapter 94

Zhou Yuan smiled.

They really guessed it. What can be solved with technology is not a problem in the face of Zhou Yuan’s master pacemaker placement surgery.

“In addition, the postoperative complications you are afraid of, such as hematoma and pneumothorax, are also technical problems…”

Zhou Yuan couldn’t bear to go on.

Going on is to pretend to be forced.

Lu Chenxi has long been accustomed to being shown by Zhou Yuan, lowered her head silently, and shouted a big man in her heart.

He Jing suddenly enlightened, staring at Zhou Yuan as if a little girl saw an idol.

Wei Lili’s face suddenly stiffened when he saw He Jing’s expression.

“He Jing, forget Zhou Yuan’s words for me! Don’t learn it!” Wei Lili said harshly.

He Jing is a good seed. You can’t let Zhou Yuan’s bad thoughts be contaminated!

The most important thing is to be stable!

Under the gaze of everyone, Zhou Yuan soon began the puncture of the subclavian vein.

Zhou Yuan chose the FAKE method of subclavian vein puncture. The needle entry point for the puncture was the middle and outer one-third of the junction between the midpoint of the sternal angle and the coracoid process. The direction of a handover point.

The needle entry point is easy to find. The difficulty is to control the puncture direction, which must be parallel to the clavicle. Once there is a deviation, the lead cannot be inserted smoothly, and there is a risk of being squeezed by the lower edge of the clavicle, which means that the operation is very likely Announced failure.

But… this is still a technical problem.

“The puncture needle.” Zhou Yuan said in a deep voice.

“The direction of the puncture needle should be as low as possible. If it is too high, the wire will enter the internal jugular vein if it is accidentally guided. Then it will be an accident in the operation.”

Zhou Yuan reminded Lu Chenxi while guiding the puncture needle into the subclavian vein.

Naturally, Lu Chenxi knew Zhou Yuan’s intentions and nodded in her heart.

“Expansion tube.”

Zhou Yuan said.

Zhou Yuan left a space between the clavicle and the first rib enough to allow the expansion tube to enter.

“Why… is it too big?” Lu Chenxi asked.

The puncture needle is much smaller than the expansion tube, so there is no need to leave so much space at all.

Zhou Yuan shook his head and said: “The reason why subclavian vein puncture is so difficult is that it is difficult to adjust the direction of puncture. Once the puncture needle and wire are inserted, they can only go in one direction…”

“In that case, why not leave a little more space so that the puncture needle has enough space under the collarbone to adjust the puncture direction?”

Lu Chenxi’s eyes widened in surprise.

Follow Zhou Yuan…I can really learn a lot of things that are not in the textbook!

“Sheath.” Zhou Yuan said, ignoring Lu Chenxi’s starry eyes.

Zhou Yuan quickly completed the puncture, leaving enough space between the clavicle and the first rib to freely adjust the direction of the puncture needle.(Read more @ wuxiax.com)

Sure enough, the speed was more than twice as fast as the cephalic vein.

Wei Lili admitted that even if she dared to get started, she would definitely not be able to do it so quickly…Because the risk is too great, she must be cautious in every step.

Because of this, the gaze looking at Zhou Yuan was even more surprised.

Zhou Yuan carefully guided the first wire with the puncture sheath, and entered through the small opening that could just accommodate the puncture sheath.

Because of the peculiarity of human physiological structure, the puncture from the right requires two bends in the thoracic cavity, while there is only one bend on the left. Zhou Yuan chose the left puncture.

Zhou Yuan had left enough space during the puncture, so when the puncture sheath and the wire reached the lower edge of the clavicle, there was no squeeze.

Once squeezed, the wire will bend, resulting in weakening of the metal conductivity, and serious wire breakage, which can only be taken out by opening the chest.

Zhou Yuan adjusted the position of the puncture sheath while staring at the fluoroscopy image next to him. Soon, he reached the ventricle smoothly.

When I got here, everyone felt nervous again.

The lead introduction of the ventricle has always been a major problem in pacemaker placement surgery. Due to the complex structure of the atrium, the atrial pectinate muscle, tricuspid valve, tricuspid chordae and other parts will hinder the smooth entry of the lead.

During the period, Zhou Yuan did encounter a tricuspid valve obstructing the advancement of the guidewire, but he only turned it a bit, then withdrew it back, and then crossed the guidewire across the valve.

Lu Chenxi and the others who saw this scene were directly dumbfounded.

This special one can still transfer?

Zhou Yuan said: “Now you understand the importance of reserving space for rotation? If you don’t leave a little space, you can only stabbed forward when you get here. You can either pierce through or try your luck to see if you can slide past.”

Lu Chenxi and He Jing both blushed and nodded.

Wei Lili stared at Zhou Yuan incredulously: “How do you feel that you are so scheming…who taught you these things?”

Zhou Yuan laughed.

“Okay, it’s done, then set up the wires and test the parameters.”

“I’m optimistic here too…” Zhou Yuan reminded Lu Chenxi.

Lu Chenxi immediately opened her eyes obediently.

At this time, the lead electrode has been sent by Zhou Yuan above the tricuspid valve opening in the right atrium.

In the fluoroscopy image, I saw Zhou Yuan rotating the guide wire, causing the electrode to deviate from the original position intermittently.

“What are you doing! Why don’t you just push the electrode from here to the right ventricle!”

As soon as Lu Chenxi finished speaking, he saw Zhou Yuan gently pushing on the side of Sun Lele’s spine. Suddenly, the electrode was sent to the nearby blood stream by this thrust. Following the blood, the electrode easily entered the right ventricle.

Lu Chenxi was dumbfounded.

Zhou Yuan didn’t want to use the puncture sheath to guide…but directly use the blood flow of the heart to drive it!

How did this come to mind…

Lu Chenxi was stupid, and only felt that it was not a young man who performed the operation in front of him, but an old fox.

“Why are you stunned, start the parameter test.”

“Oh!” Lu Chenxi said quickly, just like the little apprentice who made a mistake.

It is not difficult to test the parameters. Keep the perception greater than 5mv, the voltage threshold is less than 1v, and the impedance is between 300 and 1500 ohm.

After completing the test, Zhou Yuan performed diaphragm stimulation again, and he was relieved to see the 10v displayed on the instrument.

“No problem.”

After the ventricular lead was installed, Zhou Yuan began to install the atrial lead.

Except that the electrode parameters of the atrium are different from those of the ventricle, the other steps are similar.

Zhou Yuan soon completed the atrial wire placement.

“The wire must be properly tensioned, and it must be ligated.” Zhou Yuan said.

Lu Chenxi nodded.

“Next, the implantation of the pacemaker.”

After Zhou Yuan said this, he asked the nurse to wipe his sweat before proceeding.

The embedding of the pacemaker is simpler than the wire placement.

Zhou Yuan made an incision in Sun Lele’s chest and then buried the pacemaker in front of the fascia of the pectoralis major muscle. At this time, the lead wire was just behind the pacemaker.

“Stitches.”

Zhou Yuan fixed the wire using soluble sutures. After completing the suture fixation, he tried to pull, the wire swayed slightly, but it did not shift.

Zhou Yuan just breathed a sigh of relief.

“Why not fix it directly…” Lu Chenxi didn’t understand again.

At this point, she remembered that the wires must be reliable! But Zhou Yuan’s stitched and fixed wire is obviously shaking! .