190 Section V ■ Vascular Access

Fig. 31.9. Complication of cannulation of the radial

artery. Arrow indicates necrotic area on forearm.

Fig. 31.10. Complication of cannulation of dorsalis pedis

artery. Healing areas of sloughed skin are seen at site of skin puncture on dorsum of foot and also on anterior aspect of lower leg.

Tips of toes 1, 3, 4, and 5 are necrotic.

G. Removal of the Cannula

Indications

1. Stabilization or resolution of the indications for cannulation of the artery

2. Cannula-related infection

3. Evidence of thrombosis or mechanical occlusion of the

artery

Technique

1. Remove tape/dressing and cut stitch (if present) securing cannula to skin.

2. Remove cannula gently.

3. Apply local pressure for 5 to 10 minutes.

H. Complications of Peripheral Arterial

Cannulation

1. Thromboembolism/vasospasm/thrombosis

a. Blanching of hand, gangrene of fingertips, partial

loss of digits (14,21,22,27) Topical nitroglycerine

has been reported to restore perfusion in some cases.

(28,29) Warming of the contralateral limb, to produce reflex vasodilation, can also be used. (30)

b. Necrosis of forearm and hand (Fig. 31.9) (27,31)

c. Skin ulcers (31)

d. Ischemia/necrosis of toes (Fig. 31.10) (32,33)

e. Cerebral emboli (4,20,34)

f. Reversible occlusion of artery (14,34)

2. Infiltration of infusate (32)

3. Infection (35)

4. Hematoma (21)

5. Damage to peripheral nerves

a. Median nerve above medial epicondyle of humerus

(Fig. 31.11A) may affect the following

(1) Pronation of forearm