Iatrogenic intra-arterial injection in the upper limb: A pragmatic guide for the on-call vascular surgeon

Abstract

Background: Peripheral venous cannulation is one of the most commonly performed procedures to establish venous access in the hospital setting. Inadvertent arterial cannulation is a rare event but can have serious consequences including ischemia and limb loss, especially if medication is administered through the device. Vascular surgeons should have an understanding of the management of this potential complication Methods: We reviewed the risk factors, mechanism, pathophysiology, and management options for inadvertent upper limb arterial cannulation and injection. Results: Inadvertent arterial cannulation and administration of medication has a reported incidence of 1 in 3440 cases. Several risk factors were identified including difficult venous access, difficulty in communication, and aberrant vascular anatomy. Both arterial injury from the misplaced cannula and injection of medication can cause ischemic events through a number of mechanisms. We recommend that patients sustaining an inadvertent arterial injury should have an urgent clinical assessment and be managed according to the degree of upper limb ischemia as per the Rutherford classification. We provide a pragmatic management algorithm to aid the vascular surgeon when encountering such a situation. Conclusion: Iatrogenic arterial injury is a rare but potentially serious complication of peripheral venous cannulation. Prompt recognition and management of ischemic complications is essential for favorable outcomes. Our pragmatic management guide should aid the vascular surgeon in managing this situation.