Paeds CVP

I hate paediatric since D1 of medical school... back in my schooling day I need to assist my Mom with the babysitting job. Our financial condition was not good those days, my mom babysitted a few children - max was 3 (or maybe 4, long long time ago and I just couldnt remembered ) at a time. Baby sitting those kids was a stressful job for me. I need to "entertain them" - calm them and don't let them cry....well, I told myself - no paediatric for me...

But eventhough I did not join the paediatric department, but I still have to see kids...I tried my best though and I like those kid who was calm and interect with me in a good manner. However I still hate doing procedure on paeds patients - all those staff since so small/tiny...with my fat and short finger, I think I might just hurt them with those tools...

The youngest I intubated was those newborn who aspirated meconium stained liquor. Well, not a problem as I could see which hole I am inserting the tube. But CVPs ....the smallest I did was 6 years ago...I used an adult set ...

During my last call, there was this drowning  2 y/o child ( 1year 10month to be exact) who was brought into ED. The team did a great job manage to get a ROSC(return of spontaneous circulation) within 5 minutes. The child was sent up to ICU later. After the passover and the nurse informed me that the only IV line was leaking. The nurse "adviced" me to put in a CVP. I was reluctant to do but thinking that a CVP would save the child from a lot of puncture in the near future ( blood could be drawn via the line and saving those blood taking prick..). The nurse brought me the paeds CVP set and I swallon a big gulp of saliva - everything seems so small...
well, I used my usual method and I missed on the rt side. I told the nurse to prepare another set and tried on the left side. I had a flashed back about a scene of ED while waiting the nurse to get another set from the storeroom. The episode was about a conversation between Dr Peter Benton( he was R3 at the time) and a paediatric surgeon. Benton admired about the skill of the paeds surgeon and asked her how she did a central line without difficulty, she told Benton that she knew how the vessel runs... I took a deep breath and palpate the vessel before I cleansed and draped. I mark the artery over the inguinal area( I dare not try neck as the child was gasping on the ventilator...) with a marker pen. Then I cleansed and draped. I did a trial by puncturing just next to the line and I got it in 1 trial. The rest of the procedure was easy and I completed it within minutes. I was supposed to be happy but was unable to cheer up as I felt I am losing the child..

I did a ABG after the puncture and it revealed severe CO2 retention...I presumed he was drowned for quite some time before he was rescued. I had a conversation with the family later - they let the child play around in the yard and later found him lost. After a search they found him floating on his back in their neighbour fish bed...well, reckless and neglience parents. Reminds me to keep my children around my sight...

I told the family the baby is gonna die ,most probably on the same during the explaination session....Surprisingly they did not ask for a transfer. Most of the family would try their luck in a bigger hospital.

 I did everything I could, steroid, antibiotic etc...I did my last round at 12 MN and he was improving - the FiO2 was lower from 100% to 70% and the child had opened his eyes but his limbs was still in decerebrate posture.... I had a good night sleep, only a few calls and interuppted my sleep. I saw the child again next morning and he was better. Today he was still in our ICU, he had pneumonia but no ARDS...

I hope he recover.....