Risk of Procedures

This post summarizes the risks involved with procedures done in the neurocritical care unit.  List comes in handy when getting consent for these procedures.

 

tPA

  • intracranial bleeding 6%
  • fatal bleed 3%

 

Lumbar Puncture

  • infection: <0.01%
  • headache 22%
  • backache 25%
  • severe radicular pain 15%

 

Central Line Insertion

  • pneumothorax 6%
  • delayed pneumothorax 4%
  • hemothorax 1%
  • arterial puncture <1%
  • infection 5% per 1000 days
  • air embolism 0.5%

 

Blood Transfusion

Fever/allergic reactions 1:200
Hemolytic transfusion reactions 1:6,000
Fatal hemolytic reactions 1:1,000,000
HIV infection 1:1,900,000
HBV infection 1:180,000
HCV infection 1:1,600,000
Bacterial contamination 1:3,000
Acute lung injury (TRALI) 1:50,000
TACO 1:5000
Anaphylaxis 1:50,000

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EVD Insertion

  • hemorrhage and inadvertent placement into brain tissue 10–40%
  • EVD associated meningitis or ventriculitis 0–22%.

 

Common risks and complications (more than 5%) include:

  • Infection
  • Meningitis
  • Minor pain, bruising and/or infection from IV cannula site.
  • drain may dislodge or move

Uncommon risks and complications (1-5%) include:

  • Bleeding can occur and may require a return to the operating room.
  • Heart attack due to the strain on the heart.
  • Stroke or stroke like complications
  • Fluid leakage from around the brain
  • The drain may block and/or not drain adequately.
  • The drain may need to be replaced in the future with a more permanent diversion device.
  • Epilepsy which may require medication.
  • Small areas of the lung may collapse, increasing the risk of chest infection.
  • Increase risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
  • Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs.

Rare risks and complications (less than 1%) include:

  • Injury to the brain, important nerves or blood vessels.
  • Death as a result of this procedure is very rare.

 

 

Cerebral Angiography

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References

https://www.health.qld.gov.au/consent/documents/neurosurgery_24.pdf, 2016. Web. 21 Mar. 2016.

Carson, Jeffrey L. “Red Blood Cell Transfusion: A Clinical Practice Guideline From The AABB”.Annals of Internal Medicine (2012): E.

Joe, Zachariah, and Daroff Robert. Neurology Rapid Reponse. 2012. Print.

Kaufmann, Timothy J. et al. “Complications Of Diagnostic Cerebral Angiography: Evaluation Of 19 826 Consecutive Patients 1”. Radiology 243.3 (2007): 812-819.

Klein, Harvey G. “How Safe Is Blood, Really?”. Biologicals 38.1 (2010): 100-104.

Muralidharan, Rajanandini. “External Ventricular Drains: Management And Complications”. Surgical Neurology International 6.7 (2015): 271.

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