Wisconsin – Vascular Surgery – Perioperative Bleeding During Left Carotid Endarterectomy

On 07/10/2006, the vascular surgeon performed a left carotid endarterectomy with an AcuSeal graft on a 73-year-old woman.  At the end of the surgical procedure, protamine was administered to the patient to reverse the heparin.  Attempts to stop the oozing from the suture line continued for 80 minutes.  No clots were observed, and three ampules of thrombin were sprayed over the suture line.  Platelets were also administered, but oozing continued from the suture line.  There was no arterial bleeding.  The vascular surgeon made the decision to keep the patient intubated after the operation, and a critical care specialist was consulted.  Following the endarterectomy, the patient was admitted to the surgical intensive care unit.

In the morning of 07/11/2006, the vascular surgeon assessed the patient, including an assessment of the neck and mouth, on two occasions.  The vascular surgeon determined that in his professional opinion there was no surgical contraindication to extubate the patient.  There was a dispute between the parties as to whether the vascular surgeon issued an order to extubate the patient or whether he advised the nurse that the patient could be extubated after consultation with the intensivist.

The intensive care nurse contacted the respiratory therapist who extubated the patient.  The nurse noted in the chart that the vascular surgeon had given a verbal order that it was “okay to extubate the patient.”  When asked to complete his charts, the vascular surgeon became aware of the nurse’s entry and after consultation with the Chief of Quality Assurance, made a correction to reflect that the order had actually been that it was “okay to extubate if okay with [vascular surgeon] et. al.”  The vascular surgeon then signed both entries.

A formal complaint had been filed alleging that the vascular surgeon placed the patient at risk for harm by failing to properly evaluate the patient’s airway or to seek consultation with an intensivist prior to ordering extubation of the patient.

It is unclear from the Public Records if the patient failed extubation or if the patient developed complications from a failed extubation.

The Board understood the ongoing dispute between parties and made no determination regarding this allegation.  The Order did not constitute disciplinary action against the vascular surgeon.

The Board ordered that the vascular surgeon complete The Sterling Healthcare “The Difficult Airway Course: Anesthesia;” the “Case Western Reserve: Intensive Course in Medical Record Keeping;” and the National Center of Continuing Education’s Strategies for Developing Communication Between Nurses and Physicians.”

State: Wisconsin

Date: September 2009

Specialty: Vascular Surgery, Critical Care Medicine

Symptom: Bleeding

Diagnosis: Post-operative/Operative Complication

Medical Error: Failure of communication with other providers, Procedural error

Significant Outcome: N/A

Case Rating: 3

Link to Original Case File: Download PDF

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