Oh dear, we are still in the introductory section and already complications are rearing their ugly heads. One thing is certain, during a career in interventional radiology, there will be cases which do not follow the script. There are of course many things that can and do go wrong. Your job is to:
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Minimize predictable/preventable errors
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Recognize problems as early as possible
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Limit damage to the minimum
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Call for assistance in a timely fashion
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Learn from the experience.
An earlier section dealt with patient preparation and pre-procedure checklists; these are key to avoiding preventable errors. The remainder of this section deals with complications that arise in the course of a procedure. As the manifestations of complications are protean, it is helpful to have some form of classification to help recognize them.
Complications
Specific to a procedure
You need to be familiar with the predictable complications of a procedure, how they are likely to manifest and how they are managed; reviewing these should be part of your advance planning. Specific complications will be considered in the relevant sections.
Predictable complications range from the minor, such as a small bruise, to serious, life-threatening emergencies, which are difficult to manage. Many of these complications will feature as ‘material risks’ during discussions about the procedure and should be documented as part of the consent process.
What is clear is that it would be negligent not to rapidly diagnose and begin to manage a recognized complication. A good example is iliac rupture during angioplasty. There are typically clear symptoms and signs and there is a straightforward management algorithm to be followed to minimize the impact. When treated promptly, iliac rupture can usually be managed with relatively little clinical impact. Conversely, failure to recognize the problem and initiate treatment can lead to death.
Alarm It is your responsibility to be familiar with the recognized complications of a procedure and to be able to initiate an appropriate immediate response while seeking assistance.
Related to drugs used during a procedure
The majority of these complications are predictable from the pharmacology of the agent, sometimes in conjunction with patient comorbidities. Among the commonest are those related to sedation, analgesia and anticoagulation. It is essential to know how to reverse these agents. Contrast reactions are also a form of ‘drug reaction’ and it is important to be able to treat these promptly.
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