Successful use of topical nitroglycerine and warm compress for peripheral ischemia following arterial blood sampling in a neonate

Abstract

Although arterial catheter insertion is undertaken easily and safely, some serious complications like vasospasm, obstruction of the artery by thrombus or emboli have been reported. In the present study, a hospitalized case was reported with peripheral ischemia secondary to the brachial artery catheterization that successfully was treated with topical nitroglycerin 2% and warm compress. An early term neonate was born by the cesarean section with the first minute Apgar score 9. Immediately after birth, the subject was transferred to the NICU because of respiratory distress syndrome and subcostal retractions. Determining arterial blood gas, arterial blood sampling was ordered. Simultaneously with inserting a scalp vein in the right cubital fossa of the upper extremity, 4 fingers discolored to pale and white. Immediately scalp vein needle was removed and topical nitroglycerin 2% ointment was used while a warm compress was applied to the contralateral upper extremity. Gradual improvement in color and blood perfusion was observed in the fingers. One hour later, the white discoloration completely disappeared. Nitroglycerine 2% and warm compress to the contralateral extremity as safe and convenient measures could improve blood flow to peripheral ischemic tissues. However, in some cases more invasive pharmacological managements may be needed.