Open cannulation

[Toomuchgoingon]

Hi.

I am having a cyst removed shortly and have received a letter from the consultant which says
"because of patients increased BMI, it is likely we will carry out an open calculation"

Anyone know what this means?. I've been told that it will ideally be laparoscopic surgery but maybe laparotomy so I'm happy on that but. I just can't find anything online re the open ventilation

Help!

Do you mean cannulation, calculation or ventilation?

A cannula is for an IV line (drip) in your arm so makes no sense in the context of being open. Ventilation is machine breathing for you/ life support so again makes no sense.

No idea what an open calculation means.

It's common with a raised bmi that they will try keyhole (laparoscopic) frost but if they can't do it convert to open surgery (laparotomy).

It’s almost certainly a typo. I’d phone the consultant’s secretary and ask for clarification.

Bloody phone....open cannulation is what's written.

Heard back from the consultant
"Open cannulation is a way of getting venous access for cannulation.". So still none the wiser.......

I wouldn’t get too stressed about it OP , the surgeon has nothing to do with cannulating you that will be the anaesthetist and they are usually excellent at doing it on all sizes , shapes of people because they do it all the time . Also if they really cannot cannulate you they can do it with the aid of a type of ultrasound machine before they resort to an IV cut down .

I found one reference online about open cannulation and it appears to be something to do with the femoral artery but it could be completely unrelated..... Guess I will find out soon enough

Open cannulation is done when veins are difficult to access directly, due in your case you say, to your increased BMI. It’s a practical issue that if you are overweight and I’m sorry to be so frank, veins can’t be accessed in the normal way as they are covered by too much fat so not close enough to the surface. The doctor may use a scalpel to cut in to expose the vein in order to to insert the cannula under direct vision. This was known as a ‘cut down’ in my day.

Cannulation basically means putting a tube in another tube - most commonly people will be familiar with this in the context of putting an IV line in a vein but it could also refer to accessing things like a Fallopian tube/bile duct/artery/ureter as part of surgery. Without knowing anything about the OPs surgery it’s impossible to comment on what the surgeon who dictated the letter is referring to. I’ve been an anaesthetist for a long time and honestly have never done/seen done/ heard of anyone else doing a venous cut down to get a simple IV line in ...it just isn’t what we’d do even in people who are overweight/have terrible veins.

I’ve been an anaesthetist for a long time and honestly have never done/seen done/ heard of anyone else doing a venous cut down to get a simple IV line in

I was a sister in A&E for many years and I’ve seen this done a number of times. Maybe not current practice but it certainly was in the 80s.

Thanks for the explanations. When I've had the MRI and CT scans with dye as part of all this , they managed to get the cannula in the back of my hand, or is that a different type of cannula.

So long as they get the drugs in, I don't mind so much how they do it within reason obviously.

Agree with greybeardy. Open cannulation went out in the 90s. Never in 10 years of practice have I seen or heard of it, it's likely they'll get the ultrasound out if you're difficult. Keep your hands warm on the way to theatre, it'll help.

Thanks. If they did insist on doing it that way, is it typically still done in an arm?

@toomuchgoingon
It's really not going to happen. Not a clue what the surgeon is on about, proper dinosaur maybe. Not been done anywhere i know if for 20 years plus. Difficult venous access (which doesn't sound like you anyway if you've had CT scans) means
1, Ultrasound guided access
2, Central line, also ultrasound guided. Definitely not open.
I'd show the letter to your anaesthetist so they're aware what kind of nonsense the surgeon is coming out with.

Great thanks. I am difficult to get blood out of ( apart from the lovely phlebotomist at my surgery), so usually use a vein in the back of my hand after two or three attempts.

Guess I will find out for sure on the 23rd.

Thanks all for your input

I expect it is a typo and they mean you may end up with an open operation (laparotomy) instead of laparoscopic surgery. Laparoscopic surgery is more challenging in patients with raised BMI.

Hi all. They managed to get cannula in one hand at start of surgery but it was changed over at some point during the op. Also managed to get it done via keyhole. Phew