Abstract
We report the incidence of transient and permanent ischaemia of the forearm and hand caused by radial artery cannulation in a series of 98 newborn infants. Birth weight ranged from 550 to 3920 g (median 1600 g) and gestational age ranged from 26 to 40 weeks (median 31 weeks). In 4 of the 98 infants transient ischaemia of the forearm and/or hand occurred. In three infants the onset of ischaemia was probably related to thrombo-embolic events and in one infant to inadequate palmar collateral circulation. Permanent ischaemic damage with tissue loss did not occur in any infant. It is concluded that permanent ischaemic damage to the forearm and/or the hand with tissue loss, attributable to radial artery cannulation, is seldom encountered in newborn infants. In minimizing the risk of ischaemia, careful assessment of palmar collateral circulation prior to cannulation and of all factors predisposing to the onset of ischaemia is essential. Immediate removal of the catheter at the earliest signs of ischaemia, is essential to prevent ensuing tissue loss.
Similar content being viewed by others
References
Pearse RG (1978) Percutaneous catheterization of the raidal artery in newborn babies using transillumination. Arch Dis Child 53:549–554
Adams JM, Rudolph AJ (1975) The use of indwelling radial artery catheters in neonates. Pediatrics 55:261–265
Randel SN, Tsang BHJ, Wung JT, Driscoll JM, James LS (1987) Experience with percutaneous indwelling peripheral arterial catheterization in neonates. AJDC 141:848–851
Cartwright GW, Schreiner RL (1980) Major complication secondary to percutaneous radial artery catheterization in the neonate. Pediatrics 65:139–141
Heinonen K, Kuusela T (1982) Peripheral artery catheters in very low-birth-weight neonates. Acta Paediatr Scand 71:323–324
Adams JM, Speer ME, Rudolph AJ (1980) Bacterial colonization of radial artery catheters. Pediatrics 65:94–97
Hurt H (1984) Cosmetic defects. Peripheral arterial accidents. Clin Perinatol 11:219–220
Lin WJ, Baldomero A, Wei TJ, Kamtorn V, Sun S (1985) Percutaneous peripheral arterial cannulation (PPAC) in neonates. Pediatr Res (Abstract) 19:196
Baker RJ, Chunprapaph B, Nyhus LM (1976) Severe ischaemia of the hand following radial artery catheterization. Surgery 80:449–457
Mandel MA, Dauchot PJ (1977) Radial artery cannulation in 1000 patients: precautions and complications. J Hand Surg 2:482–495
Evans PJD, Kerr JH (1975) Arterial occlusion after cannulation. Br Med J 3:197–199
Mozersky DJ, Buckley CJ, Hagood CO, Capps WF, Dannemiller FJ (1973) Ultrasonic evaluation of the palmar circulation. A useful adjunct to radial artery cannulation. Am J Surg 126:810–812
Wilkins RG (1985) Radial artery cannulation and ischaemic damage: a review. Anaesthesia 40:896–899
Cole FS, Todres ID, Shannon MD (1978) Technique for percutaneous cannulation of the radial artery in the newborn infant. J. Pediatr 92:105–107
Gelberman RH, Blasingame JP (1981) The timed Allen test. J Trauma 21:477–479
Kamienski RW, Barnes RW (1976) Critique of the Allen test for the continuity of the palmar arch assessed by Doppler ultrasound. Surg Gynecol Obstet 142:861–864
Pfenninger J, Bernasconi G, Sutter M (1982) Radial artery catheterization by surgical exposure in infants. Intensive Care Med 8:139–141
Samaan HA (1971) The hazards of radial artery pressure monitoring. J Cardiovasc Surg 12:342–347
Mangano DT, Hickey RF (1979) Ischemic injury following uncomplicated radial artery catheterization. Anesth Analg 58:55–57
Wyatt R, Glaves I, Cooper DJ (1974) Proximal skin necrosis after radial artery cannulation. Lancet I:1135–1138
Downs JB, Rackstein AD, Klein EF, Hawkins JF (1973) Hazards of radial artery catheterization. Anesthesiology 38:283–286
Bedford RF, Wollman H (1973) Complications of percutaneous radial artery cannulation: an objective prospective study in man. Anesthesiology 38:228–236
Barr PA, Sumners J, Wirtschafter D, Porter RC, Cassady G (1977) Percutaneous peripheral arterial cannulation in the neonate. Pediatrics 59 (Suppl 6):1058–1062
Todres ID, Rogers MC, Shannon DC, Moylan FMB, Ryan JF (1975) Percutaneous catheterization of the radial artery in the critically ill neonate. J Pediatr 87:273–275
Perry MO (1983) Iatrogenic injuries of arteries in infants. Surg Gynecol Obstet 157:415–418
White JJ, Talbert JL, Haller JA (1968) Peripheral arterial injuries in infants and children. Ann Surg 167:757–766
Wehbe MA, Moore JH (1985) Digital ischemia in the neonate following intravenous therapy. Pediatrics 76:99–103
Tamai S (1982) Twenty years experience of limb replantation. Review of 293 upper extremity replants. J Hand Surg 7:549–556
Kloosterman GJ (1970) On intrauterine growth. The significance of prenatal care. Int J Obstet Gynaecol 8:895–912
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hack, W.W.M., Vos, A. & Okken, A. Incidence of forearm and hand ischaemia related to radial artery cannulation in newborn infants. Intensive Care Med 16, 50–53 (1990). https://doi.org/10.1007/BF01706325
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01706325