Lung Puncture

My 19 yr old daughter is the pm recipient. She just received her first one last month. How do I know if the lung puncture was a mistake or a complication. The Dr's never told us that making an axillary incision, so that the scar would not be seen, was more difficult than the incision under the collarbone. He ended up puncturing her lung membrane and then said it was a more difficult operation. Any feedback would be appreciated! Thanks.

10 Comments

Inga

by Tracey_E - 2013-08-21 02:08:51

If they went through every thing on the list, no one would ever sign it!

I do have two incisions, that's what I thought she was describing. They tunneled the leads from where they put them in the vein to where they buried the pm (submammary). Clever at the time, but a pita when a lead went bad.

Risk of pneumothorax

by Selwyn - 2013-08-21 03:08:52

Of course everyone having a PM inserted has to have a check chest X ray afterwards to make sure there is no pneumothorax -a common, and known complication of inserting a wire into a vein running very close to the apex of the lung.

This is something I have once done myself, I punctured some poor chaps lung inserting a catheter into his subclavian vein ( in those days there was no ultrasound, as now to lessen the risk). You get no sensation that this is happening when you manipulate the catheter.

The pleura covering the lungs) are quite thin and easy to perforate. Often the veins are thicker than the pleura. If there is a little difficulty getting into the vein with the tip of the catheter and BINGO, the catheter bounces off the vein straight into the lung cavity. POP! That's it. No ones fault really if you have carried out the procedure with due skill. I think they call it an, "Act of God".
There is never a guarantee of a perfect outcome all the time in medicine. One can only hope that the surgical procedure saved your daughter's life.

no x ray

by Alma Annie - 2013-08-21 06:08:38

No Selwyn, I did not have a chest x-ray after pm was inserted. Apparently my EP never does. Anyway all was well with me.
Alma Annie

CXR after PM insertion

by Selwyn - 2013-08-21 08:08:53

Reallly!
They would not let me leave the hospital without a chest X-ray ( CXR) after PM insertion. Had to stay overnight and wait for the X ray result before the doctors would let me leave the hospital. I remember walking around the place, trying to buy a newspaper from the hospital shop to pass the time!
Good job I didn't have a pneumothorax!

I expect around the world there may be differences in protocols.Looking at the figures, the incidence of pneumothorax following pacemaker insertion is just short of 4%. That really is quite high (1 in 25 insertions). Is a CXR, for what it is, worthwhile?

Selwyn

Tracey

by golden_snitch - 2013-08-21 11:08:19

She only has one incision, an axillary incision. What Dear was trying to say is that they made the axillary incision, but never said that this is more difficult than under the collarbone. After the lung puncture happened, they apparently tried to explain it by saying that axillary is more difficult and therefore, my guess, accompanied by a higher risk for complications like this.

Most doctors never go through all complications that are listed on the sheet you sign. BUT you still cannot blame them, YOU need to carefully read the informed consensus before you agree to it.

Inga

complications

by Tracey_E - 2013-08-21 11:08:28

Where did they put the pm that she has two incisions? Mine is different, too, the pm itself is put in from the side so the scar is under my bra and the leads are in the usual place on my chest, only it's a tiny scar and it's low enough that it's covered by most tops. They never discussed possible complications with me either, but I understood going in that burying it was more difficult that the usual collar bone placement. When a lead went bad and I got a new one a few years ago, they put in the auxillary vein but it ended up in the subclavian because that's the one that goes to the heart. They all end up in the subclavian, as far as I know.

I'm no expert but I think when lungs get punctured it happens when placing the leads after the lead is already in the vein, which means it wouldn't matter where the incision was made. Unfortunately it is a risk and while it's rare, it sometimes happens. I don't know how you could tell if it was the dr's skill or just bad luck, but know that it's not unheard of. If you do a search, you will find quite a few others here who have been through the same thing. I hope your daughter is doing better by now.

Informed consensus

by golden_snitch - 2013-08-21 11:08:52

Hi!

Lung puncture is something that is listed on every informed consenses that you sign before a pacemaker surgery. So, it's a well known risk/complication. If you sign the consensus, you declare that you are aware of this risk, but still agree to have the surgery. Therefore, the question whether it was a mistake or a complication, is easy to answer: it was a complication and you knew before that it could happen.

People often forget that all those risks and possible complications are listed for a reason, namely that a few patients will suffer from them. In other words: Someone has to be those 1% or 3% or whatever. You cannot sign the consensus and then, when one of the mentioned complications happens, blame the surgeon for it or even take him to the court.

Mayo lists this complication:
http://www.mayoclinic.com/health/pacemaker/MY00276/DSECTION=risks
Hopkins does it, too:
http://www.mayoclinic.com/health/pacemaker/MY00276/DSECTION=risks
Just to give you a few examples.

Best
Inga

No X ray

by IAN MC - 2013-08-22 01:08:28

No Selwyn I didn't have an X ray either here in Bucks UK

Ian

yes xray

by cropduster - 2013-08-22 03:08:07

UK here too but I did have a CXR before I could go home. They also went through all of the possible complications before the surgery & punctured lung was brought up, along with death!

Thanks.

by Dear - 2013-08-24 10:08:45

Thanks for all the feedback. It was explained to us that it was a risk. They actually did the best thing for her after it happened during surgery and she healed overnight so she was able to go home the next day. I have read on the internet people have gone home without even knowing that they had pneumothorax.

Her incision area is still tender but she is doing fine! She has more energy and now has color in her face!

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