I wanted to bring to your attention an excellent catch by Carrie Collins, RN. I assumed care of a patient at 3 pm receiving report from her. This patient had liver disease and was bleeding in her abdomen. She was an RRT and was going to Interventional Radiology for embolization with hemoglobin initially of 3. Typically, bedside Intensive Care Unit nurses accompany patients to Interventional Radiology for management of the intensive care portion. However, Nurse Collins recognized that this patient was medically complex and was acutely hemorrhaging. She had received 8 blood products before going to Interventional Radiology. Nurse Collins advocated that the patient have anesthesia support during the case in Interventional Radiology due to the acuity, complexity, and ASA greater than 4-5. The physician agreed, consulted Anesthesia and taken to Interventional Radiology. Just like Nurse Collins predicted, the patient was intubated in Interventional Radiology and was unable to be extubated and remained unstable for a few days after. She had to have multiple procedures due to intractable bleeding. Eventually, the patient was stabilized and was transferred to an outside hospital for a liver transplant.
Due to excellent advocacy on the part of Nurse Collins, the patient got not only appropriate but excellent care and was safe during the procedure in Interventional Radiology under anesthesia support. Nurse Collins had to jump through a few hoops, got kickback by an Interventional Radiology physician and had to convince several doctors that this is the absolute safest way. After some convincing, they agreed and we had a good patient outcome. The physician came back and told her he appreciated her advocacy on behalf of the MICU Team and the patient.