Other PICU issues

Surgical monitoring lines

A more serious issue continued to revolve around the monitoring lines that Odim employed. These lines could be used both for monitoring the patient and infusing drugs. (This was the issue that Feser had first raised with Odim at the PICU meeting of March 22.) Where Duncan had used lines that came as a single component, Odim constructed his own lines and sutured them together. According to Swartz, these lines would fall apart in the ICU.

And that would mean that the patient-that the patient was exposed or the heart-the inner chambers of the heart were exposed to air, and this can be lethal. (Evidence, pages 15,327-15,328)

On the same issue, Reimer testified that post-operative monitoring was also hindered because the transthoracic lines that Odim placed frequently came out of the heart.

The way that they were usually placed was they would be put through the wall of the heart and then tied into place with a suture. When they are tied in, obviously, the suture has to be adjusted so that it's tight enough to hold the line and not too tight that it occludes the line. But, for whatever reason, they came out on a not infrequent basis. (Evidence, pages 18,902-18,903)

Concern about the transthoracic lines was also expressed by Barwinsky, who occasionally looked after Odim's patients if he was out of town. In April, Barwinsky closed the chest of a child (CSM) who had undergone removal of a pulmonary artery band and other repairs of a complete AV canal defect. According to Swartz's testimony, Barwinsky was concerned that the monitoring lines, rather than emerging through a separate opening point, came out through the surgical wound. He was concerned when he was closing the chest that he would block or dislodge these lines.

Swartz said that she never spoke to Odim about the issue of the transthoracic lines. However, she said that Kesselman did. When Kesselman spoke with Odim about this issue, he relayed the concerns that a number of nurses had expressed about the problems with the lines. He testified that he told Odim to be more careful when constructing the lines. However, Kesselman said he could not tell Odim not to construct his own lines. Despite this conversation, Kesselman said that Odim did not change his approach to the monitoring lines. The PICU staff resorted to using wooden sticks, similar to tongue depressors, to reinforce the joints in the lines.

Post-operative bleeding and pacemaker malfunction

In addition to these concerns, the PICU staff noted that the level of post-operative bleeding in Odim's patients was higher than they would have anticipated. Dr. Walter Duncan testified it was important not to transfer a patient from the operating room to the ICU until the patient was stable and bleeding had stopped. This had been the approach followed by Dr. Kim Duncan when he had been the surgeon in the Pediatric Cardiac Surgery Program. However, Odim felt that patients recovered best and bleeding could be better addressed in the ICU, and he felt it was important to move the patient from the operating room to the ICU as soon as possible. Therefore the patients that Odim sent to the ICU suffered more bleeding than the ICU staff had expected. This difference was also one that could have been addressed during the startup phase of the program earlier in the year.