You are going to see a 5 year old post-operative patient in the ICU after presumed sepsis. During the initial surgery, you placed a 20g radial arterial line on the right side for frequent lab draws and BP monitoring. Two days after the procedure, you notice the right hand to be dusky and cool. Which of the following is NOT an appropriate treatment?
A. Remove the arterial catheter
B. Wean off of vasoconstrictive agents as tolerated
C. Direct thrombolytic therapy to radial artery with angiography
D. Surgical thrombectomy and repair of radial artery
E. Right sided cervical stellate ganglion block
F. Downsize catheter to a 22g catheter
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Answer
The answer is F. The catheter (any catheter) has to come out. Otherwise, the hand will become ischemic. Unless the kid is actively dying, find another spot for the art line. The reference below outlines the use of arterial lines. The interesting side point is answer is E. It is essentially like cutting the sympathetics to that extremity resulting in localized vasodilation. Like having neurogenic shock to the arm. They have even gone so far as to implant a spinal cord stimulator for this same reason in patients with thromboangiitis obliterans (Buerger's disease) and right arm ischemia. And you thought you were done with anatomy. May I suggest bringing this up in the ICU next time the art line isn't working.
Notes
Arterial lines -Great Ormond Street Hospital
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