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Art of Knowing When to Stop

Sometimes, interventional procedures may turn out to be more complex than expected, run into complications or just take longer than expected despite all the prior planning.

Determining the optimal endpoint in interventional procedures is a critical skill that requires a delicate balance of technical proficiency, clinical judgment, and patient-centered approach.

The key is to achieve the predetermined diagnostic or therapeutic goals while minimizing the risk of complications, procedural time and radiation dose.

Key Factors for Decision Making

  • ·Better is the enemy of the good: if you have achieved your primary goal, trying to do something extra or make it better can work against you
  • Procedural Goals: Clearly defined primary and secondary objectives of what we set out to achieve.
  • Call for help: having a second person to help with fresh perspectives when you are flustered and out of ideas
  • Real-time Imaging: Continuous assessment of procedural progress and potential complications.
  • Hemodynamic Stability: Monitoring vital signs and adjusting interventions as needed.
  • Patient Tolerance: Recognizing signs of discomfort or distress.
  • Experience and Intuition: Leveraging past experiences to guide decision-making.

Strategies for Improvement

  • Simulation: Practice on simulators to develop a sense of procedural endpoints and complications.
  • Debriefing: Discuss cases with colleagues to learn from their experiences.
  • Continuous Learning: Stay updated on the latest techniques and technologies.
  • Patient-Centered Approach: Prioritize the patient’s well-being throughout the procedure.

Patient centered approach of weighing the risks versus benefits of continuing the procedure and having a clear objective of the goals of the procedure will help to ensure the best outcomes for our patients and good sleep for us at the end of the day!

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