Recognition and management of 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.

Tip

Patients with renal failure will accumulate opiates and peak toxicity may occur after a delay of several hours. Consider alternatives for pain relief.