Severe ischemia of the hand following radial artery catheterization

Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common place procedure in the management of critically ill patients. Five patients with severe ischemia after cannulation have been encountered in the past 20 months, four of whom lost segments of one or more digits. Review of the events preceding and during radial artery cannulation allowed elucidation of the following principles: radial artery catheterization should be preceded always by a negative Allen test; the catheter should be removed after 12 to 18 hours, especially if the patient is critically ill, is hypercoagulable, or has impaired tissue perfusion; the superficial temporal artery is safer to use and permits long-term cannulation (5 to 7 days) without ill effect; and agressive approach to assessing flow and arterial reconstruction is essential if severe ischemic symptoms occur during or after radial artery catheterization. Ancillary measures, including cervicodorsal sympathetic block, intravenous low molecular weight dextran and heparin, and intra-arterial reserpine and fibrinolysin, may improve palmar circulation but should not be substituted for both noninvasive and angiographic study of arterial flow, followed by surgical restoration of flow, when indicated.