Management of an absent pulse following arterial catheterization

Abstract

Arterial cannulation is a common procedure for diagnostic as well as interventional catheterisation. The incidence of arterial damage varies from around 1% to 45 % depending on the size of the patient, size of catheters used, repeat procedures, preexisting vascular disease and whether the procedure was interventional as opposed to diagnostic (twelve times higher risk with intervention). The absence of a pulse following catheterisation can result from spasm, local thrombus formation, formation of a flap of endothelium, dissection or avulsion of the artery. In order to minimize the risks of arterial damage the following factors may help: a clean puncture, small French catheters, tapered well-fitting introducer sheaths, a short procedure time and administration of heparin (50 to 100 units/kg with further dose/s if the procedure lasts more than 75 minutes).