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

[iluvivt, BSN, RN]

You are describibg describing an extravasation, which is the inadvertent administration of a vesicant,solution or drug into the tissue that causes tissue necrosis or damage. That would mean that the catheter was out of the vessel all the way or at least partially AND the administration of the agent. No medication should ever be administered through an artery,except you have an arterial port (placed in the hepatic artery). I have a few ideas and questions. What are using to keep the art line open? How many days are you keeping the lines in place? Who inserted the lines and how much experience do they have? Is the line clearly labeled? I would be concerned that someone misidentified the line as a venous line and administered medication through it. Do you think that is a possibility? I would also be concerned about permanent arterial damage. Are you using a 20 gauge catheter? Are these all radial lines or are any brachial or femerol? Let me know as this is a very unusual occurance and I suspect it is nursing error!!

[iluvivt, BSN, RN]

Could also be severe arterial spasm,but I would suspect you would be seeing some symptoms prior to this,such as skin coolness,blanching and numbness and tingling in the area at or below the site. Is this happening?