First procedure complication

First year as an attending….

Not looking for anything just wanting to rant about my failure.

Had a younger patient non-verbal “non-functioning” with hx of seizures from nursing facility who I placed an emergent right sided IJ CVL due to sepsis and seizures and inability to gain access elsewhere. She had severe contractures of upper and lower extremities from previous childhood brain injury making other points like femoral or subclavian significantly more difficult….

She received all the rectal and IM Benzodiazepines I could throw and we managed to reduce the frequency of her seizures. I looked everywhere for a peripheral IV site and this patient had NOTHING on US. Nurses tried everything to establish an IV elsewhere and failed.

I used the US and confirmed location.. I gained access with needle and slid my catheter off and removed my needle… had very dark blood return that cycled with respiration.. I had 2 nurses with me who witnessed this. It was not pulsatile and did not look arterial…. I placed my wire without any resistance and again took my US probe and made sure the wire was within the venous lumen. I was confident but obviously incorrect at the time…. Proceeded with regular steps dilated without difficulty and placed my CVL. Flushed all my ports and secured it into place.

Post procedure chest x-ray showed the line was in the aorta…. My heart has never sunk so low before. I got physically nauseous seeing this. Called vascular and got a CT scan to confirm it was in the carotid artery. Had to place another CVL in the femoral location (extremely difficult due to body positioning and contractures of legs) and started heparin.

Pt got transferred and had to have the line removed in the OR. Turns out I had back-walled the IJ and was in the carotid.

How do you deal with this? I can’t sleep because of this. I have never had a direct complication. I’m scared I’m going to get sued. I’m chart checking daily to see how the patient is doing. How do you get your confidence back? If I had ANY doubt about my location I wouldn’t have proceeded with dilation and placement.

Looking back I could have done an IO but figured that since she had responded to the meds and was sitting still long enough I could just go straight to a CVL. I also want to point out she was not having a seizure while I was placing the CVL.

I don’t know what I’m expecting putting this out on Reddit. Please feel free to roast me but I just needed to put this out somewhere.

Thank you.