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Table of Contents
LETTER TO EDITOR  
Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 76-77
Accidental cannulation of aberrant radial artery


Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India

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Date of Web Publication2-Jan-2014
 

How to cite this article:
Sathish N, Prasad S R, Nagesh K S, Jagadeesh A M. Accidental cannulation of aberrant radial artery. Ann Card Anaesth 2014;17:76-7

How to cite this URL:
Sathish N, Prasad S R, Nagesh K S, Jagadeesh A M. Accidental cannulation of aberrant radial artery. Ann Card Anaesth [serial online] 2014 [cited 2019 Nov 14];17:76-7. Available from: http://www.annals.in/text.asp?2014/17/1/76/124165


The Editor,

Incidence of superficial aberrant radial artery has been reported to be 0.8-1%. [1],[2] Its unawareness may lead to accidental intra-arterial injection of therapeutic drugs, complications and litigation. We report a case of aberrant radial artery cannulation, which was recognized early and managed.

A 20-year-old male was scheduled for double valve replacement. After attaching standard monitors, an intravenous access was secured by an anesthesia technician on the radial aspect of the right wrist joint with an 18 G cannula after applying tourniquet [Figure 1]. An unusual backflow was noted after the removal of the tourniquet and the color of the blood was bright red. With the suspicion of the aberrant radial artery cannulation a fluid bag was connected, which showed pulsatile backflow into the tubing. This was further confirmed by attaching a transducer, which showed arterial waveform [Figure 2] and by blood gas sampling, which showed findings corresponding to arterial blood gas. It was decided to continue with this line for arterial pressure monitoring for induction. Arterial pulse on the usual site of the right radial artery was feeble, but showed definitive flow on Doppler. The radial artery course was normal on the left side. An intravenous line was secured on the dorsum of the left hand with an 18 G cannula. After induction of anesthesia femoral artery was cannulated for further arterial pressure monitoring which was continued post-operatively. The cannula placed in the aberrant radial artery was removed in the immediate post-operative period.
Figure 1: Aberrant radial artery accidentally cannulated with 18 G cannula

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Figure 2: Arterial waveform after transducing

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The reported incidence of accidental arterial cannulation and injection is 1 in 56,000 to as common as 1 in 3440. [3] Common sites for accidental arterial cannulation are radial aspect of the wrist where the aberrant radial artery is confused with the cephalic vein. Other common sites for accidental arterial cannulation are antecubital area where brachial artery is superficial and accidentally cannulated mistaking with antecubital vein and groin region where femoral artery is accidentally cannulated mistaking with the femoral vein especially in patients with hypotension and low saturation. Accidental intra-arterial injection of drugs causes severe pain and paresthesia followed by vascular insufficiency. Accidental arterial cannulation is detected by the presence of pulsation in the vessel proximal to the site of cannulation; and by the presence of pulsatile backflow of bright red blood in the cannula; the accidental cannulation of aberrant artery can be further confirmed by transducing the pressure in the cannulated vessel and by blood gas analysis of the sample collected from the cannulated vessel. [4]

Treatment of inadvertent intra-arterial injection includes keeping the cannula in situ, local infusion of heparin saline and systemic anticoagulation with heparin. Other measure includes local anesthetics injection, calcium channel blockers, intra-arterial papaverine, stellate ganglion block and axillary plexus block.

 
   References Top

1.Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: A morphological and statistical study, with a review of the literature. J Anat 2001;199:547-66.  Back to cited text no. 1
    
2.Wood SJ, Abrahams PH, Sañudo JR, Ferreira BJ. Bilateral superficial radial artery at the wrist associated with a radial origin of a unilateral median artery. J Anat 1996;189:691-3.  Back to cited text no. 2
    
3.Sen S, Chini EN, Brown MJ. Complications after unintentional intra-arterial injection of drugs: Risks, outcomes, and management strategies. Mayo Clin Proc 2005;80:783-95.  Back to cited text no. 3
    
4.Ghouri AF, Mading W, Prabaker K. Accidental intraarterial drug injections via intravascular catheters placed on the dorsum of the hand. Anesth Analg 2002;95:487-91.  Back to cited text no. 4
    

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Correspondence Address:
S R Prasad
Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Bangalore - 560 069, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124165

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