Vascath into an Artery
24/11/10
- unfortunate complication with possible serious sequelae for the patient.
- well recognized but uncommon
POTENTIAL COMPLICATIONS
- bleeding (hypovolaemia, haemothorax)
- haematoma formation with compression of surrounding structures (trachea, cervical plexus,
veins, oesophagus, pleural, vagus)
- embolism of atherosclerotic plaque -> CVA
- inadvertent administration of drugs before position recognized
MANAGEMENT
Immediate
- notify vascular surgeon -> will probably require surgical haemostasis given size of the hole
in artery (direct closure or patching)
- leave catheter in situ unless causing vascular insufficiency to the brain
- if surgical repair not indicated and catheter removed -> prolonged pressure must be
maintain on artery until surgical assessment has been made (be aware of potential problems:
carotid body compression and distal flow)
- patient should ideally be intubated (probably already is given is in multi-organ failure)
- correct coagulopathy (cessation of anti-platelets and anti-coagulants, blood products, factor
VIIIa)
Post-removal of line
- assess end organ injury (brain function – clinically +/- imaging)
- keep intubated until haematoma + swelling settled
- extubate after ensuring coagulopathy resolved and airway not threatened
Other issues
-
root cause analysis
discussion with trainee (non-judgemental, supportive)
open disclosure with family and patient
follow up with family and trainee
education (U/S guidance teaching)
hospital event form
full documentation
Jeremy Fernando (2011)