Catheterisation of the brachial artery in children: should we be so concerned?

2020 ◽  
Vol 22 (2) ◽  
pp. 173-173
Author(s):  
Alexander Hussey ◽  
◽  
Sainath Raman ◽  
◽  
Keyword(s):  
Critical Care ◽  
Brachial Artery ◽  
Haemodynamic Monitoring ◽  
Limb Ischaemia ◽  
Local Infection ◽  
Life Saving ◽  
Acute Limb Ischaemia ◽  
Permanent Occlusion ◽  
Temporary Occlusion ◽  
Critical Care Patients

To the Editor: Arterial catheterisation is often indicated for critical care patients to allow continuous haemodynamic monitoring and to facilitate blood sampling. However, it is associated with complications, with some considered minor (eg, bleeding, haematoma, local infection and temporary occlusion) and others considered major, requiring urgent limb- and/or life-saving treatment (eg, permanent occlusion, acute limb ischaemia, pseudoaneurysm and sepsis).

Limb ischaemia and below-knee amputation following life-saving patent ductus arteriosus stent in a critically ill infant

2014 ◽  
Vol 25 (6) ◽  
pp. 1206-1209
Author(s):  
Apinya Bharmanee ◽  
Srinath Gowda ◽  
Harinder R. Singh
Keyword(s):  
Ventricular Septal Defect ◽  
Patent Ductus Arteriosus ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Limb Ischaemia ◽  
Knee Amputation ◽  
Pulmonary Flow ◽  
Life Saving ◽  
Acute Limb Ischaemia ◽  
Patent Ductus

AbstractLimb ischaemia is a rare but catastrophic complication related to cardiac catheterisation. We report an infant weighing 3 kg with unrepaired tricuspid atresia type 1b, small patent ductus arteriosus, and ventricular septal defect presenting with cardiogenic shock owing to progressively reduced pulmonary blood flow from closing ventricular septal defect and patent ductus arteriosus. An emergency palliative ductal stent was successfully placed with marked clinical improvement. However, acute limb ischaemia developed necessitating above-knee amputation, despite medical management and vascular surgery. The cause of limb loss in our patient was catheterisation-related vascular injury causing arterial dissection–arterial thrombosis in the presence of shock and coagulopathy. This report emphasises the complexity in managing limb ischaemia associated with coagulopathy and highlights the importance of early recognition of reduced pulmonary flow in a single ventricle patient. Timely elective placement of a surgical systemic to pulmonary shunt would prevent catastrophic clinical presentation of compromised pulmonary flow and avoid the need for an emergent life-saving intervention and its associated complications.

scholarly journals Volkman’s Contracture, Persistent Limb Ischaemia, and Amputation: A Complication of Brachial Artery Catheterisation for Haemodynamic Monitoring Using PiCCO

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Veejay Bagga ◽  
Marion Palmer ◽  
Ramesh Sadasivan ◽  
Govindan Raghuraman
Keyword(s):  
Brachial Artery ◽  
Multiorgan Failure ◽  
Pulse Contour Analysis ◽  
Pulse Contour ◽  
Haemodynamic Monitoring ◽  
Limb Ischaemia ◽  
Contour Analysis ◽  
Left Hand ◽  
Limb Perfusion ◽  
Analysis System

We report a case of a 64-year-old woman who was admitted to intensive care unit with multiorgan failure secondary toPlasmodium falciparummalaria. Haemodynamic monitoring using the transpulmonary thermodilution with pulse contour analysis system (PiCCO) was achieved via the left brachial artery. Two days later, a flexion deformity of the left hand was noted, and examination revealed left lower arm ischaemia. Removal of the catheter resulted in an immediate improvement of the contracture. However, distal pulses were still absent, and the arm remained ischaemic resulting in a below elbow amputation. This is the first documented case of a persistent limb ischaemia following the insertion of an arterial catheter for haemodynamic monitoring with PiCCO. We therefore highlight the need for regular assessment of limb perfusion after arterial catheterisation for haemodynamic monitoring with PiCCO. In addition, the brachial artery should be avoided, and femoral artery catheterisation is recommended.

Haematological drugs

2019 ◽  
pp. 235-243
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Tranexamic Acid ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Successful Outcome ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Surgical Bleeding ◽  
Traumatic Bleeding ◽  
Definition Of ◽  
Critical Care Patients

This chapter discusses haematological drugs and includes discussion on anticoagulants and heparin-induced thrombocytopenia (including unfractionated heparin, low-molecular weight heparins, danaparoid, coumarins, synthetic pentasaccharides, the direct oral anticoagulants, and thromboprophylaxis in critical care patients), thrombolysis (definition of thrombolysis, physiology of fibrinolysis, contraindications to thrombolysis, factors influencing a successful outcome, myocardial infarction, acute limb ischaemia, and pulmonary embolism), and antifibrinolytics (describing the efficacy of tranexamic acid in reducing traumatic bleeding, the efficacy of tranexamic acid in reducing surgical bleeding, and the efficacy of tranexamic acid in postpartum haemorrhage).

Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump

2020 ◽  
pp. 1-2
Author(s):  
James Elliott ◽  
Anand Iyer ◽  
James Elliott
Keyword(s):  
Pulmonary Vein ◽  
Ct Angiography ◽  
Mediastinal Lymph Node ◽  
Case Reports ◽  
Common Femoral Artery ◽  
Sudden Onset ◽  
Leg Pain ◽  
Limb Ischaemia ◽  
Left Upper Lobectomy ◽  
Acute Limb Ischaemia

Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].

scholarly journals The pathophysiology of “happy” hypoglycemia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Thomas Loeb ◽  
Anna Ozguler ◽  
Geraldine Baer ◽  
Michel Baer
Keyword(s):  
Critical Care ◽  
Hemorrhagic Shock ◽  
Lactate Production ◽  
Severe Hypoglycemia ◽  
Altered Mental Status ◽  
Case Presentation ◽  
Energy Substrate ◽  
Tissue Hypoperfusion ◽  
The Brain ◽  
Critical Care Patients

Abstract Background Hypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma. Case presentation We report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism. Conclusions Following the example of the “happy hypoxemia” recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of “happy hypoglycemia.”

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

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