INSERTION-RELATED COMPLICATIONS

Arterial Access

When attempting to access a vein, you may inadvertently access an artery. If arterial access is suspected, pull out immediately and apply pressure, observe site for hemostasis. Reattempt access, if repeat arterial access consider repositioning patient, changing sites or use of ultrasound.

Symptoms of arterial access include:

• Bright red bleeding or pulsatile blood flow from the needle
• Difficulty when dilating the vein
• Formation of a hematoma at the insertion site

Prevention/Management
Palpate the position of the arteries before accessing a vein. The use of ultrasound during insertion is an effective way to prevent arterial puncture.

Most clinicians would simply remove the needle and continue the procedure at the same site. On the other hand, if a large bore catheter or sheath is fully cannulated into an artery, the catheter should be left in place and immediate consultation obtained from a vascular surgeon and/or interventional radiologist. If vessel access is questionable, use of a pressure transducer is encouraged. Simply place the transducer blunt transduction probe into the access of Raulerson syringe and attach tubing to a pressure transducer to monitor the waveform. Other new technologies also allow for inline pressure transduction for mean arterial or venous waveforms.