Intra-arterial verapamil to reverse acute ischaemia of the hand after radial artery cannulation

Gallacher, Bernard P.

doi:10.1007/bf03009180

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…116 -119,182,188 -190,249 -251 Aspiration of the thrombus at the catheter tip has been described to restore arterial pulsation in 60% of patients with suspected thrombosis. 117,118,195,248,250 Other proposed treatments include low-molecular-weight dextran and low-dose heparin. 117,118,195,248,250 Other proposed treatments include low-molecular-weight dextran and low-dose heparin.…”

Section: Treatment Of Ischemic Complicationsmentioning

confidence: 99%

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

287

226

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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%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

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Section: Treatment Of Ischemic Complicationsmentioning

confidence: 99%

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

287

226

View full text Add to dashboard Cite

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“…19 Although radial nerve blockade, as described by Bhakta and Zaheer, 1 is a relatively simple solution to arterial linerelated RAS, an effective treatment may also be achieved with intra-arterial injection of vasodilators. 20 Not surprisingly, neither of these strategies has been subjected to rigorous scientific scrutiny as to their effectiveness, duration of action, etc. Moreover, while it seems plausible that arterial cannula-related RAS can be a precursor to thrombosis, ischemia, and ultimately target organ damage, 21 the nature of this relationship and the confounding effects of patient comorbidities and clinical circumstances (e.g., hypothermia, excessive blood loss, hypotension, etc.)…”

mentioning

confidence: 99%

“…19 Bien que le bloc du nerf radial, tel que décrit par Bhakta et Zaheer, 1 constitue une solution relativement simple au SAR liée au cathétérisme radial, un traitement efficace peut également être obtenu par l'injection intra-artérielle de vasodilatateurs. 20 …”

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Radial artery spasm: Should we worry?

Backman

2017

Can J Anesth/J Can Anesth

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“…Systemic anticoagulation, intra-arterial verapamil, and balloon angioplasty with localized abciximab or low molecular weight dextran are the first-line therapies for patients without bleeding risks. However, the effect of these therapies is limited when angiographic intervention is unsuccessful [ 10 , 11 ]. Invasive angiography can visualize the injured vessels directly and provide a vehicle for the direct injection of vasodilatory agents to the site.…”

Section: Discussionmentioning

confidence: 99%

Finger necrosis after accidental radial artery puncture

et al. 2014

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Radial artery puncture, an invasive procedure, is frequently used for critical patients. Although considered safe, severe complications such as finger necrosis can occur. Herein, we review the clinical course of finger necrosis after accidental radial artery puncture. A 63-year-old woman visited the emergency department (ED) with left second and third finger pain after undergoing intravenous (IV) access in her wrist for procedural sedation. During the IV access, she experienced wrist pain, which increased during the 12 hours prior to her ED presentation. Emergency angiography revealed a pseudoaneurysm in her left radial artery and absence of blood flow to the proper palmar digital artery. Subsequent angiointervention and urokinase thrombolysis failed. The second finger was eventually amputated owing to gangrene. Radial artery puncture can occur accidentally during IV wrist access, resulting in severe morbidity. Providers should carefully examine the puncture site and collateral flow, followed by multiple examinations to ensure distal circulation.

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Intra-arterial verapamil to reverse acute ischaemia of the hand after radial artery cannulation

Cited by 8 publications

References 3 publications

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Radial artery spasm: Should we worry?

Finger necrosis after accidental radial artery puncture

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