Start with the emergency physician

Zhou Yuan smiled.

They really guessed correctly, what can be solved with technology is not a problem in front of Zhou Yuan’s master-level pacemaker placement surgery.

“In addition, the postoperative complications you are afraid of, such as hematomas, pneumothorax and so on, are also technical problems…”

Zhou Yuan couldn’t bear to continue.

To go on is to pretend.

Lu Chenxi had long been accustomed to being treated by Zhou Yuanxiu, and silently lowered his head, shouting a big guy in his heart.

He Jing was suddenly cheerful, staring at Zhou Yuan as if the little girl saw an idol.

When Wei Lili saw He Jing’s expression, her face suddenly froze.

“He Jing, forget Zhou Yuan’s words for me! Don’t learn! Wei Lili said sternly.

He Jing is a good seedling, can’t let Zhou Yuan’s bad thoughts be polluted!

Stability is the most important!

Under the gaze of everyone, Zhou Yuan soon began the puncture of the subclavian vein.

Zhou Yuan chose the subclavian vein puncture FAKE method, the needle entry point of the puncture is the midpoint of the sternum angle and the middle and outer third of the coracoid process connection, and the direction of the puncture is the direction of the needle entry point and the middle and inner third of the clavicle.

The needle entry point is easy to find, the difficulty is the control of the puncture direction, it must be parallel to the collarbone, once there is a deviation, the wire cannot be placed smoothly, and there is a risk of being squeezed by the lower edge of the clavicle, which means that the operation is very likely to be declared a failure.

But…… Again, it’s a technical problem.

“Puncture needle.” Zhou Yuan said in a deep voice.

“The direction of the puncture needle should be as low as possible, if it is too high, the slightest carelessness will lead the wire into the internal jugular vein, and then it will be an accident of surgery.”

Zhou Yuan reminded Lu Chenxi while guiding the puncture needle into the subclavian vein.

Lu Chenxi naturally knew Zhou Yuan’s intentions, and nodded in his heart.

“Expansion tube.”

Zhou Yuan said.

Zhou Yuan left a space between his collarbone and the first rib that was large enough to allow the dilator to enter.

“Why… Isn’t it too big? Lu Chenxi asked.

The needle is much smaller than the dilator and does not need to leave so much space at all.

Zhou Yuan shook his head and said, “The reason why subclavian vein puncture is very difficult is because it is difficult to adjust the direction of the puncture, once the puncture needle and lead are inserted, it can only pass in one direction…”

“In that case, why not leave a little more space so that the needle has enough space under the collarbone to adjust the direction of the puncture?”

Lu Chenxi’s eyes widened in surprise.

Follow Zhou Yuan… You can really learn a lot of things that are not in textbooks!

“Sheath.” Zhou Yuan ignored Lu Chenxi’s starry eyes and said.

Zhou Yuan quickly completed the puncture, leaving enough space between the collarbone and the first rib to adjust the direction of the needle freely.

Sure enough, the speed was more than twice as fast as the cephalic vein.

Wei Lili thought that even if she dared to get started, she would never be so fast… Because the risk is too great, she has to be cautious every step of the way.

Therefore, he looked at Zhou Yuan’s gaze.

Zhou Yuan carefully guided the first wire with the puncture sheath, entering through a small opening just enough to accommodate the puncture sheath to pass through.

Because of the particularity of human physiological structure, piercing from the right side requires two bends through the chest cavity, while there is only one bend on the left, and Zhou Yuan chose the left puncture.

Zhou Yuan had left enough space when he pierced, so when the puncture sheath and wire reached the lower edge of the collarbone, there was no compression.

Once extruded, the wire will bend, resulting in weakened metal conduction, and even the wire will break in serious cases, and it can only be taken out with an open chest.

While staring at the perspective image next to him, Zhou Yuan adjusted the position of the puncture sheath, and soon, he smoothly reached the ventricle site.

When they arrived here, everyone became nervous again.

Ventricular lead introduction has always been a major problem in pacemaker placement surgery, due to the complex structure of the atrium, the atrial comb muscle, tricuspid valve, tricuspid valve tendon cord and other parts will hinder the smooth entry of the lead.

During this period, Zhou Yuan did encounter a tricuspid valve to block the progress of the wire, but he just turned around, then withdrew, and crossed the lead over the valve.

Lu Chenxi and the others who saw this scene were directly dumbfounded.

What else can this turn on?

Zhou Yuan said, “Now you understand the importance of reserving space for rotation?” If you don’t leave a little space, you can only stab forward when you get here, either by stabbing or by trying your luck to see if you can slide through. ”

Lu Chenxi and He Jing both blushed a little and nodded.

Wei Lili stared at Zhou Yuan incredulously: “How do you feel that you are so sophisticated… Who taught you these things? ”

Zhou Yuan smiled.

“Okay, done, let’s place the wires and test the parameters.”

“It’s also good here…” Zhou Yuan reminded Lu Chenxi.

Lu Chenxi’s eyes immediately widened obediently.

At this time, the lead electrode has been sent by Zhou Yuan above the opening of the tricuspid valve in the right atrium.

In the perspective image, I saw that Zhou Yuan rotated the guide wire, causing the electrode to intermittently deviate from its original position.

“What are you doing! Why not push the electrode directly from here to the right ventricle! ”

As soon as Lu Chenxi finished speaking, he saw Zhou Yuan gently pushing on Sun Lele’s spinal side, and suddenly, the electrode was sent to the blood stream next to him by this thrust, and along the blood, the electrode easily entered the right ventricle.

Lu Chenxi was stunned.

Zhou Yuan didn’t want to use the piercing sheath to guide… Instead, it is directly driven by the blood flow of the heart!

How did you come up with that…

Lu Chenxi was stupid, and he only felt that the person who was performing the operation in front of him was not a young man, but an old fox.

“Why are you stunned, start the parametric test.”

“Oooh!” Lu Chenxi hurriedly said, like a little apprentice who made a mistake.

Parameter testing is not difficult, keep the perception greater than 5mV, the voltage threshold less than 1V, and the impedance at 300~1500ohm.

After completing the test, Zhou Yuan performed diaphragm stimulation again, and was relieved to see the 10V displayed on the instrument.

“No problem.”

After the ventricular leads were placed, Zhou Yuan began to place the atrial leads.

Except that the electrode parameters of the atria are different from those of the ventricles, the other steps are similar.

Zhou Yuan quickly completed the placement of the atrial lead.

“The wire must be given the proper tension, and it must be ligated.” Zhou Yuandao.

Lu Chenxi nodded.

“Next, the embedding of the pacemaker.”

After Zhou Yuan said this, he let the nurse wipe his sweat before continuing.

Pacemaker embedding is simpler than wire placement.

Zhou Yuan made an incision in Sun Lele’s chest, and then buried the pacemaker in front of the fascia of the pectoralis major muscle, and the electrode wire was just behind the pacemaker.

“Stitches.”

Zhou Yuan fixed conductor uses soluble suture. After completing the suture fixation, he tried to pull, and the wire swayed slightly, but did not shift.

Zhou Yuan was relieved.

“Why don’t you fix it directly…” Lu Chenxi didn’t understand again.

At this point, she has the impression of ensuring that the wire is reliable! But the wire that Zhou Yuan stitched and fixed was obviously shaking! _

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