Arterial Thrombosis After Arterial Cannulation or Puncture

 

After cannulation thrombosis in an artery is:

(1) directly related to the size of the cannula (the larger the catheter, the higher the risk; inversely related to the gauge of catheter)

(2) directly related to duration of cannulation (there is a marked increase in risk after 3 days)

(3) directly related to the degree of difficulty and trauma during the cannulation procedure (number of punctures required, presence of a hematoma)

(4) inversely related to the diameter of the artery

(5) inversely related to the rate of blood flow in the artery

(6) directly related to how much the catheter fills the arterial lumen (highest risk when there is a large catheter in a small artery)

 

For a 20-gauge catheter in the radial artery:

 

percent incidence of occlusion if cannulated 1-3 days =

= (67.5 - (25.9 * (artery lumen diameter in mm)))

 

percent incidence of occlusion if cannulated 4-10 days =

= (118.5 - (37.7 * (artery lumen diameter in mm)))

 

Interventions that reduce thrombosis associated with an arterial catheter:

(1) continuous flush system used

(2) prompt removal of a nonfunctional catheter

(3) therapy with aspirin and/or low dose heparin

 

Complications of thrombotic occlusion depends on:

(1) presence of collateral circulation

(2) embolization

 

Complications of infection depend on:

(1) length of time the cannula is in place

(2) aseptic technique at the time of insertion

(3) care during cannulation