The 'life-saving' device triggers a 'deadly' infection, making it difficult to perform precise surgery and 'bomb disposal'
Author：admin Time：2024-06-29
Number ：166
On June 19th, Liu Bing, Vice President of the Heart Hospital at Xi'an International Medical Center Hospital, led a team to collaborate with multiple disciplines and successfully removed a ruptured pacemaker from a patient with Brucella bacteria. The patient has now been transferred back to the local hospital for rehabilitation treatment. 11 years ago, a pacemaker implanted with pus and ulceration "drilled" out of the body Jiafang (pseudonym) has an uneven and ulcerated skin under her left collarbone, revealing the pacemaker she implanted 11 years ago. The pacing electrode connected to the pacemaker extends into the heart, supporting a heartbeat at a rate of 60 beats per minute. One month ago, the tissue around the pacemaker was infected, and the cyst broke out. The local hospital attempted anti infective treatment, but the results were not satisfactory. On the recommendation of the director of the cardiology department at the local hospital, Jiafang took a train overnight to find Liu Bing.
2 multidisciplinary consultations throughout the hospital and 6 family interviews The pacemaker has been with 70 year old Jiafang for 11 years, and after 6 conversations, Jiafang vows to remove the "curse". The pacing electrode is tightly attached to the blood vessels and surrounding tissue endometrium. When the pacing electrode is pulled out of the myocardium, it is like pulling out a radish to remove mud. The risk of blood vessel tearing, heart rupture, and perforation is extremely high. Hospitals that have the ability, willingness to take risks, and can carry out this technology are numerous. In addition, patients with Class B infectious disease - brucellosis - find it difficult to safely remove the pacemaker. What method should be used if surgical removal is required? What special surgical instruments are needed? In which operating room is it conducted? How to resist the risk of nosocomial infection of Class B infectious diseases? What are the contingency plans for the risks encountered during surgery? Vice President Liu Yantong, Vice President Zhang Bin, Director of the Medical Education Department Feng Junqiang, and Director of the Infection Control Office Liu Bing of Xi'an International Medical Center Hospital participated in the consultation. Dr. Wang Haichang, Director of the Cardiology Hospital, Dr. Li Weijie, Executive Director, Dr. Su Yingjun, Director of the Wound and Scar Prevention and Treatment Center of the Plastic Surgery Hospital, Dr. Yang Jinbao, Deputy Chief Physician of the Cardiology Department, Dr. Zhang Yutao, Deputy Chief Physician of the Anesthesiology and Surgery Department, Infectious Diseases Department, Ultrasound Diagnosis and Treatment Department, Blood Transfusion Department, Pharmacy Department and other multidisciplinary experts consulted and refined the surgical plan to each step. Finally, a temporary pacemaker was implanted to completely remove the infected wound and cyst, and then the ventricular and atrial pacing electrodes were removed one by one. 222 minutes of life and death appointments inside and outside the operating room A surgery is a matter of life and death between doctors and patients, with the collaboration of multiple departments in the hospital behind it. The spare machine for anesthesia surgery has been debugged "The DSA operating room has been disinfection and sterilization according to the requirements of sensory control!" The cardiac surgery department has prepared extracorporeal circulation equipment and personnel are all in place The blood transfusion department has prepared the blood In the operating room, Liu Bing, Su Yingjun, and surgical assistant Wu Feng, dressed in lead coats, N95 masks, and equipped with protective face screens, "confronted the enemy head-on". Outside the operating room, the medical staff preparing the table have been fully dressed and are ready to receive chest opening intervention at any time. Li Weijie "supervised" next to the DSA monitor, never taking his eyes off the screen. On the screen, the site where the pacemaker was infected with bacteria was peeled off layer by layer, exposing a surgical field of view with a surface as hard as an eggshell. There were repeatedly infected pus cavities under the wound, constantly producing purulent secretions. Su Yingjun carefully separated the wound, cleaned it, and rinsed it to avoid inserting the infected tissue into the blood vessels during removal.
The surgical process was more difficult than expected, taking only one hour. If the debridement is not thorough, the subsequent work will be in vain.
Under contrast imaging, the separation process is not intuitive, and surgery largely relies on the doctor's experience and "feel". The pacing electrode adhered too tightly to the blood vessel. Liu Bing held the locking probe with one hand to anchor the pacing electrode and establish a "track", while the other hand slowly advanced the mechanical expansion sheath to separate the fibrous tissue adhered along the electrode lead.
Complete removal of two pacing electrodes. After 222 minutes, a silent, high-risk, and difficult "battle" came to an end in the DSA operating room. As one of the first cardiovascular experts in China to carry out the implantation and removal of pacemakers, Liu Bing stated that the department always puts patients at the center, synchronizes with international advanced diagnostic and treatment levels, and solves patients' "major concerns".
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