Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists

The use of indwelling arterial catheters has become increasingly widespread in pediatric patients in recent years. As experience has expanded so has awareness of the complications that their use may entail. We report a case of a 9-month-old patient with Reye's syndrome who suffered diffuse microvascular compromise, which resulted in partial loss of an extremity following radial artery catheterization. CASE REPORT A 9-month-old male infant, previously in excellent health, was seen with a three-day history of rhinorrhea and cough, a one-day history of vomiting, and a 12-hour history of lethargy. When seen at a local hospital he had status left-sided focal seizures and a serum glucose of 17 mg/100 ml.

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Acute Arterial Ischemia in a Neonate: Complication of an Indwelling Radial Artery Catheter

Journal of Neonatology ◽

10.1177/0973217918794997 ◽

2018 ◽

Vol 32 (2-3) ◽

pp. 67-70

Author(s):

Harshil Anurag Patel ◽

Amee Atulkumar Amin ◽

Dipen Vasudev Patel ◽

Somashekhar Marutirao Nimbalkar

Keyword(s):

Unfractionated Heparin ◽

Radial Artery ◽

Perinatal Depression ◽

Surgical Intervention ◽

Full Term ◽

Clinical Monitoring ◽

Term Newborn ◽

Radial Artery Catheterization ◽

Left Radial Artery ◽

Radial Artery Catheter

A full-term newborn with perinatal depression, meconium stained liquor, shock, and hypoglycemic seizures was admitted at a hospital after 70 hours of life. He was ventilated, received antibiotics, and vasopressors. After 8 hours of left radial artery catheterization, ischemic changes appeared on tips of all the fingers of the newborn. The catheter was removed, and intravenous unfractionated heparin was started. Arterial Doppler revealed thrombus in both radial and ulnar arteries. The case was of category III (irreversible) acute arterial ischemia. Review Doppler after 4 days showed low resistance and dampened flow in radial and ulnar arteries. Surgical intervention was not done. Aspirin was given at discharge, and at 40 days, the distal end of the metacarpals was affected. The positive modified Allen’s test and close clinical monitoring did not guarantee the safety of radial artery catheterization. Other measures need to be critically evaluated to identify evolving thrombus early.

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A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Journal of Interventional Cardiology ◽

10.1155/2020/7928961 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Dmitrii V. Ognerubov ◽

Alexander Sedaghat ◽

Sergey I. Provatorov ◽

Andrey S. Tereshchenko ◽

Olivier F. Bertrand ◽

...

Keyword(s):

Coronary Angiography ◽

Randomized Trial ◽

Hospital Discharge ◽

Radial Artery ◽

Ulnar Artery ◽

Artery Occlusion ◽

Puncture Site ◽

Coronary Procedures ◽

Baseline Characteristics ◽

Radial Artery Occlusion

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

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