1. Injury from X-ray exposure. Acceptance of X-rays is mandatory and can be resolved by shortening the duration of the procedure, switching to surgical bypass treatment in complicated cases and completing the procedure in stages.
2. Contrast allergy and contrast nephropathy.
Risks to medical personnel:
1, X-ray damage long-term high-dose exposure, the incidence of cancer, blood disorders, clouding of crystals, and hypogonadism is significantly higher than that of other populations. Protection: spare lead clothing, lead caps, lead glasses and gonadal protection. Digital flat panel vascular machine can reduce the rays.
2, medical risk: intraoperative deaths and complications are a certain incidence, as long as the do, may occur. Adequate informed documentation and communication with the patient can increase the understanding of the patient's family.
3, business risk: high technical requirements. Need experienced, technically pure personnel to operate.
Preventive measures:
1. Allergic reaction
Preventive measures: 1. Do allergy test in advance, use non-ionic contrast agent, and give dexamethasone 5-10mg IV into a small pot before operation for high-risk patients.
2. Contrast nephropathy: a few patients will have a transient increase in blood creatinine, high-risk patients (DM, multiple myeloma, blood volume insufficiency, pre-existing renal impairment and the use of nephrotoxic drugs) have transient renal damage, reaching less than 1% of the need for dialysis treatment. Post-imaging cholesterol renal embolism occurs at a very low rate.
Preventive measures: Avoid the use of drugs that are damaging to renal function, such as aminoglycosides, ACEIs, or nonsteroidal anti-inflammatory drugs.B, use of nonionic contrast agents.C to reduce the dosage of contrast, the total amount of which should not be more than 3 ml / kg or 5 ml / (kgCr) (mg%).C, before and after the intervention of 12 hours of continuous use of 0.9% NaCL [1 ml / kgh] hydration D, For patients with pre-existing renal impairment (Cr>2mg/dl), use isotonic, nonionic contrast agents in addition to controlled contrast dosage (minimal intraoperative position and smoking). The incidence of severe renal impairment or failure (Cr>5mg/dl at 48h postoperatively) can be significantly reduced by maintaining a urine output of >150ml/h postoperatively.E. At Cr>2.5mg/dl along with the contrast agent >140ml, administration of a high dose of N-acetylcysteine (2× 1200 mg) IV. has a role in combating contrast nephropathy.
3, infection (including local and systemic), local infection is mostly cellulitis, abscess, while sepsis, bacteremia is systemic infection.
Preventive measures: A. Strict sterilization and implementation of aseptic operation. B. Do not use sterilization expired instruments and supplies. C. Do not use No. 2 supplies. D. Postoperative antibiotics to prevent infection.
4, acute myocardial infarction or other important organ embolism. Cerebral embolism,cerebral hemorrhage,pulmonary embolism.
Preventive measures: take antiplatelet drugs and anticoagulants according to the requirements of evidence-based medicine. Spare coagulation monitoring equipment to monitor coagulation function in time. Intraoperative clean operation. Use aspiration thrombus catheter or intracoronary application of tirofiban in patients with heavy thrombus load. High-risk patients should be guided by relevant departments or specialists. Try to minimize the patient's bedtime.
5. Acute heart failure, shock, DIC. vasovagal reflex (VVR).
Preventive measures: closely monitor the patient's vital signs. Focus on the patient's blood volume monitoring. Control contrast dosage. Control the operation time. Prepare resuscitation drugs and IABP.
6. Hematoma after femoral artery cannulation, clinically significant retroperitoneal hematoma and hemorrhage, vascular occlusion, cholesterol embolus, arteriovenous thrombosis, arteriovenous phlebitis, vasospasm, vascular tear, vascular entrapment, secondary vascular stenosis, occlusion, arteriovenous leakage (AVF), and pseudoaneurysm (PSA).
Precautions: approach from the radial artery in patients without contraindications. Avoid puncture by unsure physicians. Train physicians in anatomy and puncture techniques. Be gentle and cautious and avoid repeated puncture. Use small-sized vascular sheaths except for special instruments or the anastomosis technique. Avoid removal of the vascular sheath during the heparinization time, and apply compression hemostasis for a full 20 minutes or more, using a vascular stapler if necessary.
7, coronary perforation, pericardial tamponade. Cardiac rupture, valve damage resulting in closure insufficiency, requiring cardiac surgery.
Preventive measures: scientific selection of devices, the ratio of the diameter of the blood vessel to the balloon or stent should be 1:1.1 or less, try not to high-pressure dilatation, the use of SAFECUT, if necessary, without the use of plaque removal devices and intravascular ultrasound. Try not to use hard guidewires.
Preventive measures: scientific selection of devices, the diameter ratio of the vessel to the balloon or stent should be below 1:1.1, try not to dilate at high pressure, use SAFECUT when necessary, do not use plaque removal equipment and intravascular ultrasound. Try not to use hard guidewires.
8. Death and other accidents.
Preventive measures: continuous training, continuous learning, standardized operation. All personnel should concentrate, do their best and cooperate well. Strive to reduce the mortality rate and respond to unforeseen circumstances. Keep the mortality rate below the data reported in the literature.