Radial artery catheterism for invasive monitoring: Preventing complications, a challenge in anesthesia

Abstract

IntroductionRadial artery line placement is a common intervention in anesthesia. There is a sensation of false safety generated by the relatively low complication incidence. Identification of the primary association factors and controversies on the matter are key for prevention of complications. MethodsWe present the case of a female patient who suffered permanent ischemia in her hand after inserting a catheter in the radial artery. A reflexive review of the literature on risk factors and controversies on interventions that have been implemented is included. ResultsPlacing a line in the radial artery may cause permanent ischemic injuries in as much as 0.09% of cases. 38% of cases develop thrombosis with the procedure, the risk of thrombosis increases over time and remains even after removing the cannula. The Allen test has shown to be a poor predictor of ischemic lesions. Age, use of tobacco, diabetes, renal failure and arterial hypertension are all risk factors for radial artery atheromatosis. Other elements such as the size and the material the catheter is made of, have also been related to the risk of complications. Infusions through the catheter remain a controversy. Ultrasound guides for catheterism eases the procedure. ConclusionsThis procedure is definitely not without risks. Even though many factors have been carefully documented they cannot be fully controlled and interventions aimed at prevention have not been proven to be effective.