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S.N. Myatra et al.

 

 

Step 17: Treat ischemic complications if they occur

Hand ischemic—remove the cannula.

Monitor patient’s condition and use splinting.

If the patient is on vasopressors, stop therapy if possible.

If the patient’s condition is medically stable, consider the following:

Arterial duplex sonography

Angiography

Operative intervention. if the patient’s condition is medically unstable, consider the following:

Arterial duplex sonography

Sympathetic block

Use of thrombolytics

Step 18: Remove the arterial catheter at the earliest

There is no fixed number of days after which the arterial catheter should be removed. Catheter colonization increases with dwell time. Hence, assess the need for the arterial catheter daily and remove it as soon as it is no longer required or earlier if there are any complications.

Suggested Reading

1.Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg. 2009;109(6):1763–81.

Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%.

2.Wallach SG. Cannulation injury of the radial artery: diagnosis and treatment. Algorithm Am J Crit Care. 2004;13(4):315–9.

Cannulation of the radial artery can result in complications ranging from arterial thrombosis, arterial aneurysm, compartment syndrome, infection, nerve injury, and skin necrosis to possible thumb or even hand necrosis if not recognized and treated early.

3.Koh DB, Gowardman JR, Rickard CM, Robertson IK, Brown A. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Crit Care Med. 2008;36(2):397–402.

In this study, arterial catheter colonization and rates of catheter-related bloodstream infection were found similar to those in concurrently sited and identically managed central venous catheters. By inference, the arterial catheter should be given the same degree of importance as the central venous catheter as a potential source of sepsis.

4.Del Cotillo M, Grane N, Llavore M, Quintana S. Heparinized solution vs. saline solution in the maintenance of arterial catheters: a double blind randomized clinical trial. Intensive Care Med. 2008;34:339–43.

The use of heparinized solution for arterial catheter maintenance does not seem to be justified as it did not increase the duration of the catheters, nor did it improve their functionality significantly. On the other hand, heparin Na altered aPTT significantly.

5.Hoste EA, Roels NR, Decruyenaere JM, Colardyn FA. Significant increase of activated partial thromboplastin time by heparinization of the radial artery catheter flush solution with a closed arterial catheter system. Crit Care Med. 2002;30:1030–4.

A heparinized flush solution for the arterial catheter, when used together with a closed-loop blood sampling system, leads to erroneous results of heparin-sensitive coagulation studies.

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