Arterial Line Extravasation

[rnseb65]

I need some information. Has anyone had issues with tissue necrosis occurring above a previous A-line site? We have had 4-5 in the last 18 months. There was no peripheral line in that arm, no evidence that the patient had anything but the A-line there. The patients exhibited symptoms like a dopamine infiltrate with the severity reaching need for possible surgical intervention. I'm trying to find a common factor in an attempt to solve this mystery. Thanks Sue

[RazorbackRN, BSN, RN]

I have seen problems like this before, though rarely, and usually it is distal to the a-line site. The artery will start to spasm after having the cath in for a while and hence blood flow is hindered.

You can usually tell that the aretery is having spasms because you will have a more dampened waveform and also the skin at the site will blanch when being flushed.

Typically, whenever we start noticing this, we have papaverine added to the pressure line. This helps the artery to relax. If we continue to have issues, then the line will be placed elsewhere, but most of the time this works.

[Elvish, BSN, DNP, RN, NP]

Moved to MICU/SICU in hopes of more responses. :)

[trvlngrn22]

Just a thought, could someone have possibly used this line as an IV? I just saw a post where someone asked what the difference was between a-lines and central venous lines and have heard of an a-line being used in error for an IV push....scary thought but something to consider if your access is showing signs similar to a dopamine infiltration.

[lovelynurse123456]

I need information too

[NotReady4PrimeTime, RN]

Just a thought, could someone have possibly used this line as an IV? I just saw a post where someone asked what the difference was between a-lines and central venous lines and have heard of an a-line being used in error for an IV push....scary thought but something to consider if your access is showing signs similar to a dopamine infiltration.

This has definitely happened in our unit, when the art line was confused for the central line and drugs were pushed or infused into them. We also had three incidents where D10W was used for the flush solution (and the resulting "hyperglycemia" treated with insulin... our ABG results also include electrolytes). I've also seen instances where a periperal IV was actually arterial and the resulting injuries were quite nasty.

[KR]

I need some information. Has anyone had issues with tissue necrosis occurring above a previous A-line site? We have had 4-5 in the last 18 months. There was no peripheral line in that arm, no evidence that the patient had anything but the A-line there. The patients exhibited symptoms like a dopamine infiltrate with the severity reaching need for possible surgical intervention. I'm trying to find a common factor in an attempt to solve this mystery. Thanks Sue

Like others have mentioned, I would wonder about the A-Lines being used by mistaked as IV access.

Several questions though:

1-How long have these A-Lines been in?

2-Is it the same doctor that has been putting in the problematic A-Lines?

3-Have you changed the brand of A-Lines remotely recently?

Typically, whenever we start noticing this, we have papaverine added to the pressure line. This helps the artery to relax. If we continue to have issues, then the line will be placed elsewhere, but most of the time this works.

I have never heard of papverine. Would you happen to have a link on it? I am going to google it, but thought I would ask since I was already replying to this thread.

Thanks,

Kimberly

[SteveNNP, MSN, NP]

We used to use papaverine in all our arterial lines in the last NICU I worked in, and it really worked well to keep those tiny arteries from clamping down. I belive we used 60 mg per 500ml 1/2NS.

http://en.wikipedia.org/wiki/Papaverine