Preventing Complications of Diagnostic Catheterization: Some Cognitive and Philosophical Issues, and a Couple of Critical Techniques
The usual chapter on complications of catheterization procedures would follow an outline listing the most frequent and most serious complications, with some discussion of how to deal with them. Most of the discussions focus on either the prognostic factors involved in predicting complications, risk scoring systems, the management of specific complications, or sometimes frightening illustrations of the worst outcomes in a variety of settings. The probability of each complication is delineated and referenced. It is sometimes confusing to read discussions of risk predictors for percutaneous coronary interventional procedures because risk scoring systems are derived from population statistics, and applying a probability score to an individual patient is intangible, usually not accurate, and highly unsatisfying. In fact, for an individual patient, the probability of a complication is either 0 or 100%. This ‘boiler plate’ book chapter on complications is available in many places, from many sources, and from excellent writers. I will take advantage of this chapter as an opportunity to approach the subject differently. Table 42.1 shows a classification for complications, based on the broad categories under which most complications fall. This discussion will not follow such an outline, but rather will relate some of the strategies involved in complication management that are more intangible, and are not part of the usual discourse of such a discussion. The performance of catheterization procedures certainly requires a substantial amount of didactic and technical training, and a great deal of practice to develop the skills necessary for the technical aspects of procedure performance. In training programs and at meetings we dwell on these technical details, including equipment choice, balloon compliance curves, pharmacodynamics, and the sizing of balloons and stents. Despite the technical demands of coronary interventional procedures, catheterization is at least more than 50% cognitive, and in my opinion is closer to 75 or 80% cognitive and/or philosophical. I will discuss some of the cognitive aspects of the prevention and management of complications during diagnostic cardiac catheterization, and touch on some
of the technical and procedural points I think are particularly important.