Venous complication rate

Abstract

Carrougher, Kadakia, Shaffer, and Barrilleaux finally document the widespread belief that midazolam is less likely to cause venous complications than does diazepam.1Carrougher JG Kadakia S Shaffer RT Barrilleaux C. Venous complications of midazolam versus diazepam.Gastrointest Endosc. 1993; 39: 396-399Abstract Full Text PDF PubMed Scopus (19) Google Scholar There is a related question that has interested me for some time: Is there a difference in the venous complication rate as a consequence of whether the infusion takes place in the left arm versus the right arm? The speculation behind the question is that the left arm, being dependent in the left lateral posture typical of both upper and lower endoscopies, has a more stagnant blood flow than does the right arm. This might be the case inasmuch as the blood flow from the right arm, being superior and of lower venous pressure in this posture, has an unimpeded return flow to the heart, whereas that of the left arm not only has a higher venous pressure but also is likely further encumbered in its return to the heart by the “pinch” on the left axillary vein in this posture by the weight of the upper body. Such a difference in venous return flow characteristics might cause a difference in venous complications as well.