Complications of Angiography and Angiogram Procedure

Complications of Angiography/Angiogram Procedure

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Complications of Angiography/Angiogram Procedure

Overview of Angiography

Coronary Angiography is an invaluable test, used for the detection of coronary artery disease, identification of any existing structural or valvular abnormalities and for measuring hemodynamic parameters (Tavakol et al., 2012). Simply put, Angiography is an X-ray used to check blood vessels, with the help of a special dye injected in the human blood. The dye highlights the blood vessels, allowing the doctors to see any existing coronary problems. These X-Ray images that are created during Angiography, are called Angiograms (NHS, 2020). 

The Angiograms can detect or diagnose conditions related to blood vessels, like atherosclerosis, aneurysms, peripheral artery disease, angina, pulmonary embolism, to name a few (NHS, 2020).  

Complications of Angiogram Procedure

Since Angiography is an invasive procedure, the complications of Angiogram procedure are patient-dependent and procedure-related (Tavakol et al., 2012). The complications may range from minor problems that can have short term sequelae to life threatening conditions that could cause an irreversible damage, if left untreated without giving any urgent care (Tavakol et al., 2012). Below are listed the main complications of Angiogram procedure:

Allergic and Adverse Reactions

Some of the allergic and adverse reactions may arise due to local and general anesthesia. For instance, vasodepressor anesthesia, asthma-like reactions and anesthesia toxicity can occur because of local anesthesia. On the other hand, general anesthesia can lead to anaphylactoid reactions that may happen with conscious sedation agents and more likely occur after contrast media. Such complications can be treated with potential use of oxygen, bronchodilators and histamine blockers, depending upon the severity of the anaphylaxis. In more severe cases, endotracheal intubation and urgent consultation is made with the anesthesia team (Tavakol et al., 2012).

Infections

Although rare, infections can occur after invasive-cardiovascular procedures. The likelihood of catheter-related infections is less than 1% (Munoz et al., 2001). Additionally, it can be seen that the infection is unlikely to occur immediately after the procedure. For instance, in a study of 147 consecutive blood cultures after the complex catheterization procedures, 18% subjects indicated positive blood cultures immediately after procedure and 12% indicated positive blood cultures after 12 hours of procedure, and none of the patients developed clinical signs of infection (Tavakol et al., 2012). 

Other Complications of Angiography

Contrast-Induced Nephropathy (CIN) is one of the serious complications of Angiogram procedure, that can have short- and long-term sequelae. CIN is a condition in which the serum creatinine levels rise ≥ 0.5 mg/dl or 25% above the baseline value, that can have potential long-term outcomes such as renal impairment requiring hemodialysis, and even death (Tavakol et al., 2012). 

The pathogenesis of CIN is quite multifactorial. The Contrast media has an effect on a wide range of vasoactive substances like adenosine, nitrous oxide, along with direct cytotoxicity through the free radicals (Barrett & Carlisle, 1993; R. Solomon, 2005) that have been implicated as the potential causes of Nephropathy (Tavakol et al., 2012). 

There are some other complications of Angiography, including but not limited to Cholesterol Emboli, Local Vascular Injury leading to problems like Thrombosis and Embolism, and Conduction disturbances like bradyarrhythmia, tachyarrhythmia, Myocardial Infarction, Cerebrovascular complications, to name a few. 

Conclusion

Concludingly, Angiography is a diagnostic procedure, that is used to detect coronary artery diseases and for the detection of likelihood of any structural and vascular abnormalities. It can detect various cardiac abnormalities and is thus, an invaluable procedure. However, there occur few complications ranging from Infections, Nephropathy, Anaphylaxis, and other complications like Local vascular injury, Conduction disturbances, to name a few. Although, the risk factors are patient-dependent and procedure-related, for each individual, the potential benefits should be weighed against the risk factors, including the morbidity and mortality, basis which the procedure of Angiography should be performed.

References

Barrett B. J, Carlisle E. J. (1993) Metaanalysis of the relative nephrotoxicity of high- and 

low-osmolality iodinated contrast media. Radiology. 188(1):171–178. [PubMed] [Google Scholar]

Munoz P, Blanco J. R, Rodriguez-Creixems M, et al. (2001) Bloodstream infections after 

invasive nonsurgical cardiologic procedures. Arch Intern Med. 161(17):2110–2115. [PubMed] [Google Scholar]

NHS (2020) Angiography Overview. National Health Service. Available at 

https://www.nhs.uk/conditions/angiography/ Accessed: 10 June, 2021

Tavakol, M., Ashraf, S. and Brener, S.J. (2012) Risks and Complications of Coronary --

Angiography: A Comprehensive Review. Glob J Health Sci. doi: 10.5539/gjhs.v4n1p65 Available at

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777042/ Accessed: 10 June, 2021 

Legal and Ethical Issues in Nursing: Individual Case Analysis

Legal and Ethical Issues in Nursing – Individual Case Analysis

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Legal and Ethical Issues in Nursing – Individual Case Analysis

Overview of Andrea’s Nursing Case

This paper takes a closer look at the case of Andrea, a nurse employed at a long-term facility in Canada. Despite being overworked and having given her resignation to the manager at the facility, she chose to stay with the patients on the night she administered drug over dosage to the resident patient, Mrs. Smith, as there was no nurse stationed for the night duty. The first part of this case discusses whether Andrea was completely responsible for the patient’s death, followed by the role of coroner in the death case investigation and the last part would investigate about the resources that Andrea could use in response to the charges of professional misconduct, malpractice, and a criminal charge.

Part 1: Nursing Malpractice and Responsibility for Patient Death

Andrea’s case is an example of Nursing Malpractice as the case relates with the failure to carry out her duties in a responsible and careful manner (Legal and Ethical Issues in Nursing, 2021). According to Keatings and Adams (2019), the nurse who fails to take charge of the safety of their patients, shares subsequent responsibility of the consequences caused due to such an incompetence on their part. Thus, Andrea is responsible for the death of their patient. However, considering the scenario, Andrea had already given their resignation and stayed at the facility as there was no nurse to take care of the patients, the Manager and the management of the facility are also vicariously liable for the death of the patient. In one of the trials, the judge of the court explained that the hospital can be liable for the negligence of their conduct or vicariously liable for the conduct of their employees when they act in the scope of their employment (Legal and Ethical Issues in Nursing, 2021). Despite Andrea’s complaint about the nurses’ overburden, the manager persuaded them to stay with the patient and thus, the management is vicariously liable for the death of Mrs. Smith. In this case, Andrea should accept her medical negligence but should also let the legal authorities know about the situation prevailing at the facility where the nurses are overburdened with taking care of 40 patients at a time in one shift. 

Part 2: Coroner Investigation and Determination of Cause of Death

In Andrea’s case, the coroner was called on the next morning when Andrea administered Mrs. Smith with the wrong dosage of Morphine. A Coroner is an independent judicial officer who investigates the matters of death, reported to them (nidirect.gov.uk, n.d.). The circumstances under which the coroner is called in include, if the doctor did not treat the patient last night or there is a case of negligence or the patient died because of administration of an anesthetic (nidirect.gov.uk, n.d.). A coroner should be called upon when there is a case of death under suspicious circumstances or a death is unexpected or unexplained (nidirect.gov.uk, n.d.).

  In Andrea’s case, since the death of Mrs. Smith occurred post administration of evening dosage of the drug after Andrea left the facility, and it was unexpected, it therefore, required a coroner to investigate the case. As evident from the medication record of coroner, the narcotic count that Andrea had given to Mrs. Smith was 100 mg of Morphine instead of 10 mg, as ordered. This proves, that Andrea was at fault. The next steps that the coroner would take, include, signing of medical certificate by a doctor, followed by taking the medical certificate to the registrar to register the death and finally, the coroner would issue a certificate to the registrar if a post-mortem is not needed (Gov.uk, n.d.). Since, in Andrea’s case, it was evident that Mrs. Smith died of Morphine over dosage, post-mortem was not required. Lastly, since the cause of death of Mrs. Smith is Respiratory arrest because of over-dosage of Morphine, Coroner’s report would include incidence of nursing malpractice i.e., History of Morphine over dosage by the nurse that led to the respiratory arrest of Mrs. Smith.

Part 3: Legal Resources and Response to Professional Charges

As evident, Andrea made a mistake by administering the higher dosage of Morphine, against what was ordered and that led to the death of her patient, Mrs. Smith. The first step that Andrea should take is to contact the healthcare provider or her manager, carry out their orders, assess and document the actions. The fear of lawsuit would definitely creep in Andrea’s mind and she would have to face the charges of malpractice, professional misconduct and a criminal charge. In such a situation, after notifying the manager, Andrea should contact her insurer who could guide her best about how to respond to the incident (nursingcenter.com, 2003). She must admit her mistake and should act as a prudent nurse should act in the given situation. The resources that could best help her out of the situation could be state’s nurse practice act, other statutes, regulations governing nursing, the law’s governing patient’s rights, confidentiality of medical records and finally, non-discrimination for employees (nursingcenter.com, 2003).

Conclusion

Andrea’s case is a case of professional misconduct, malpractice and negligence. The case shows that Andrea was overburdened of work, such that the facility she was working in would cater to 40 patients per one nurse in each shift. This would have definitely impacted her state of mind and that could have led to administration of over dosage of drug to the patient, Mrs. Smith. Although, the case is an example of professional misconduct and malpractice on the part of the nurse and vicarious liability on the part of the facility, the case had to be registered by the coroner owing to the unexpected death of the patient. Although, one must be utmost careful while handling patients and should be wary of administering drugs, in particular. However, if such cases arise, the nurse must contact their supervisor and manager for the advice and should follow the required laws and statutes that could protect them.

References

Gov.uk (n.d.) When a death is reported to a coroner. Gov.uk. Available at

https://www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner

Kestigian, A. & London, A.J. (2016). Adversaries at the Bedside: Advance Care Plans and 

Future Welfare. Bioethics, 30 (8), 557-567.

http://onlinelibrary.wiley.com/doi/10.1111/bioe.12263/abstract?campaign=woletoc

Legal and Ethical Issues in Nursing (2021) Lesson 4: The Nurse’s Legal Accountabilities and 

End-of-Life Issues. 

nursingcenter.com (n.d.) Nurse’s Guide to Malpractice: Module 3. Nurses Service Organization.

Available at https://www.nursingcenter.com/upload/journals/documents/200303nsoce3sued.htm

nidirect.gov.uk (n.d.) Coroners, post-mortems and inquests. Nidirect government services. 

Available at https://www.nidirect.gov.uk/articles/coroners-post-mortems-and-inquests 

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