failed central line...

The technique of inserting a central catheter had been improvised since 20 years ago. I had heard that one of it was utilizing color Doppler to locate the vein before puncture. But as a man of action working in ED, I preferred the traditional way to visualize the anatomy and proceed with the puncture. 90 % of the time, I am par to my standard. But yet, from time to time, I will tripped over by my own shoe lace..

This patient is an elderly male suffered from latent  Tuberculosis. He had presented to our OPD and ED with multiple complaint after starting his medication. However, he was hypotensive on this presentation. He was not tachycardic though. I decided to flush him with fluid via a central line before I start the dopamine drip. The catheterization process gone smooth before the guide wire insertion part; obstruction was noted when the wire was passed beyond the 15cm line. I retracted the wire and reinserted it. Still I faced the obstruction at the 15cm mark. I redrawn the wire and did a blood drawing trial and it was smooth. I proceeded with the wire insertion part (still 15cm..) and inserted the catheter. Everything was smooth and fluid was flushing with no problem…

I grinned when I saw the follow up xray. I ordered a full run of 2000cc of fluid and removal of the catheter after the flushing.

This is the first time, I inserted the catheter into the subclavian vein; I had multiple insertions into the internal jugular vein and I am familiar with the “obstruction” encounter during those insertions. Well, it still serve it function anyway…

1/2 of Summer trip

I had gone for camping trip in the Qing Jing Area earlier this week.  I had planned this trip 2 months ago when I decided to cancel my Malaysia trip for this summer holiday. It was a tough decision for me to cancel the trip back to the Boleh Land but yet I had to give in. Yun and Xian had to attend summer school during July and we had only a window of 8 days to perform the trip which I consider to be inadequate. 

It would be my second time to try out my Coleman Weather Master 10p Tent. We had been to Qingjing few years ago for a brief stop and camped for only 1 night. I had booked a camp site for a 3D2N stay and planned to visit the sheep breeding farm. I had spread the news over the Line camping group and 4 other families had joined our trip.

The most difficult part was the booking. It opened on the 1^st of June for booking and I had made 800+ redial in 2 hrs before I got through; it was summer holiday and nothing to shout.

We pushed out early at 8am and reached Puli town at 11am where we stopped for lunch. The trip to the 1750m camp site took us about 40mins. Fefe had problem during the last 10 mins of the climb. Gear jamming was noted, the gear was fixed at 3^rd gear and unable to downshift to 2^nd gear. It was a protective mechanism of the gear box. I was not surprised that it happened at 1700m during the climb(it only happened at 2900m few years ago). Fefe was loaded with 5 persons (last time it was 4) and a huge load of equipment. We settled at 3:30pm and enjoyed the cool temperature of 20C (vs 35C down south).

There was a 7-11 outside the camp site and the younglings had grabbed every chance to go for a tour. The elders had some cash and were able to buy freely with the younger one looking and fascinating around the store without the supervision of their guardians. I knew the feeling and told them to grab one items of their choice and paid up. Their grin on the face pacified my soul and I had repeated my act several times during that period.

We were lucky as despite of the weather forecast which indicate possible lighting storm in the afternoon; the camp site was dry during that period.

The drive back home was smooth and as usual, I was back to my desk that evening due to shortage of staff.

It was a prep trip for me as we are going to the Wuling Farm for camping next months. It would be a strenuous drive since the Wuling Farm is 120km farther than the QingJing Farm. The 120 km include another climb from 1750 to 3000m above the sea level and descend again to 1400m. The Curvy winding mountain road leading to the destination would cost us 3-4 hrs of drive. I would be sending Fefe for a service before the trip; hopefully with the less weight and service, Fefe will be able to made it through the journey without choking.

Taiwan is a camper friendly country with many camp sites which are safe and well equipped with clean wash room and electricity supply. 

Camping is reminder to Yun and Xian that we do not necessary need to stay in top graded hotel during our travel. I told them that comfort is a relative term and we should enjoy what we had at that specific moment and praise to the great one for the grace.