Follow golden rules to avoid interventional complications

Fatal complications resulting from interventional procedures can be avoided in up to half of cases if radiologists follow the correct procedures. Being familiar with good technique, understanding the desired end point of any procedure, and knowing when to ask for help are keys to success.

These and other points were the focus of an RSNA education exhibit developed by Dr. Julia Gates and Dr. George Hartnell, radiologists at Baystate Medical Center at Tufts University in Springfield, MA.

"Discussion of major complications, especially fatalities, seems to be very limited," the team noted in its exhibit. "The need to retain peer-review confidentiality impairs widespread discussion. Fear of malpractice also limits acknowledgment of responsibility, but much can be learned from past errors."

Key tips from the exhibit include:

• Do not get carried away when going solo for the first time. Before performing a new procedure, radiologists should ask for advice from an experienced colleague. Read all the charts and study the previous images.

• When starting out, understand imaging, particularly MR angiography.

• Be familiar with good angiographic technique. Know the equipment and use it to your advantage. Never use brute force when advancing a wire through an artery. Manipulate catheters and wires gently, especially in cases of severe generalized atherosclerosis.

• Know and appreciate the desired end point of any procedure. For example, to minimize the chance of gastroesophageal reflux and aspiration, patients should be fed via a nasojejunal tube to reduce total gastric residual volume.

• Allow a reasonable amount of time to perform the procedure correctly.

• Work as a consultant, rather than as a service provider. Perform procedures when they are indicated. Speak with referring colleagues.

• The risk of death should be mentioned when obtaining consent for most, if not all, interventional procedures.

• Know when to ask for help. If a procedure takes longer than usual, consider whether it is appropriate, if you are missing something, or if help is needed.

• Follow-up with patients at home by telephone.

"Hoping for a good outcome may not be enough," the authors noted. "The unexpected can and does happen. When patients ask, "Can I die from this?" the answer should be yes. Even a peripherally inserted central catheter can cause a fatal arrhythmia.

See the Society of Interventional Radiology guidelines for likely mortality rates (www.sirweb.org)."