Complications, Recognition, and Emergency Management
Domain 7: Complications, Recognition, and Emergency Management
This domain tests early recognition and first response to mechanical, infectious, thrombotic, and infusion-related complications.
Core rules
- Early mechanical: arterial puncture, haematoma, pneumothorax, haemothorax, nerve injury, arrhythmia, air embolism, catheter malposition.
- Late: catheter-related bloodstream infection, thrombosis, occlusion, fracture, migration, phlebitis, infiltration, extravasation.
- Air embolism: sudden dyspnoea, chest pain, hypotension, cyanosis. Clamp catheter, place patient in left lateral Trendelenburg, give 100% oxygen, call for urgent help.
- Extravasation: stop infusion, aspirate residual drug through the cannula if appropriate, remove device, elevate limb, apply cold or warm compress according to drug, and use antidote per protocol. Document.
- Arterial puncture: remove needle or catheter, apply firm pressure for at least 5–10 minutes, assess distal perfusion, and escalate if expanding haematoma.
- Suspected infection: obtain cultures as ordered, do not delay treatment; remove device if indicated.
Worked example
During PICC removal, the patient suddenly coughs, becomes hypotensive, and desaturates. Reasoning: consider air embolism. Clamp the catheter, position left lateral Trendelenburg, give oxygen, call the emergency team, and document timing. Do not sit the patient upright and wait.
Traps
Flushing against resistance; ignoring pain or swelling; massaging a thrombosed vein; delaying removal of a septic device; and failing to record the complication and actions.