What is the MOST likely complication associated with the placement of a radial artery catheter in an adult?
(A) Hematoma
(B) Transient arterial occlusion
(C) Local infection
By some estimates, about 8 million arterial catheters are placed annually in the United States, with the radial artery being the most common site. A review published in 2002 summarized radial artery complications in 19,617 cannulations (Table). The most common complication was transient arterial occlusion (19.71%), followed by hematoma at 14.40%. Local infection has been reported in less than 1% of radial artery cannulations. Other rare complications have been reported, including radial or median nerve damage, air embolism, and compartment syndrome.
Table: Incidence of complications from radial artery placement. Information from Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine (Crit Care 2002;6:199-204. doi: 10.1186/cc1489).
The radial artery at the wrist has an inner diameter of approximately 3.1 to 3.8 mm and is larger in diameter than the ulnar artery at the wrist in 87% of patients. In other publications, placement of an arterial catheter has been reported to lead to complete arterial occlusion in 24% - 40% of patients within eight days of decannulation. Recannulation of the artery may then take as long as 75 days (Figure).
Figure: Recannulation of the radial artery after thrombosis. Time courses of recannulation in 20 patients whose arteries had become thrombosed. Used with permission, from Bedford RF, Wollman H. Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology 1973;38:228-36. doi: 10.1097/00000542-197303000-00006. © 1973 American Society of Anesthesiologists. All rights reserved.
Figure: Recannulation of the radial artery after thrombosis. Time courses of recannulation in 20 patients whose arteries had become thrombosed. Used with permission, from Bedford RF, Wollman H. Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology 1973;38:228-36. doi: 10.1097/00000542-197303000-00006. © 1973 American Society of Anesthesiologists. All rights reserved.
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Answer: B
