Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series

Julie Paik, Ram Hirpara, Jennifer A. Heller, Laura Hummers, Fredrick Wigley, Ami Shah

Research output: Contribution to journalArticle

Abstract

Objective: To demonstrate potential thrombotic complications after radial arterial line placement in patients with scleroderma. Methods: This is a retrospective case series of 4 patients with scleroderma who were hospitalized in the intensive care unit (ICU) requiring invasive hemodynamic monitoring and developed severe complications after radial arterial line placement. We reviewed their medical records to assess their laboratory findings and clinical presentations. Results: All 4 patients met the 2013 ACR/EULAR criteria for systemic sclerosis and had a radial arterial line placement in the setting of invasive hemodynamic monitoring. Overall, 2 of 4 patients had arterial line placement during surgery; while 1 patient had it placed for invasive blood pressure monitoring during an ICU admission for renal crisis; and 1 patient had arterial line placement during cardiac resuscitation, but before administration of vasopressor support. In all, 3 of 4 patients had major ischemic events including digital gangrene, hand auto-amputation, and below-elbow amputation. Among all, 1 patient had temporary hand ischemia with recovery of perfusion with immediate arterial line removal within 24 hours. Conclusions: Radial arterial line placement may trigger critical ischemic events in scleroderma patients. This experience suggests that placement of radial lines needs to be thoughtfully weighed prior to insertion in patients with scleroderma, and alternative options should be carefully considered.

Original languageEnglish (US)
JournalSeminars in Arthritis and Rheumatism
DOIs
StateAccepted/In press - 2016

Fingerprint

Vascular Access Devices
Systemic Scleroderma
Amputation
Intensive Care Units
Hand
Hemodynamics
Gangrene
Elbow
Resuscitation
Medical Records
Ischemia
Perfusion
Blood Pressure
Kidney

Keywords

  • Arterial line placement
  • Raynaud's phenomenon, Systemic sclerosis
  • Vasculopathy

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

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title = "Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series",
abstract = "Objective: To demonstrate potential thrombotic complications after radial arterial line placement in patients with scleroderma. Methods: This is a retrospective case series of 4 patients with scleroderma who were hospitalized in the intensive care unit (ICU) requiring invasive hemodynamic monitoring and developed severe complications after radial arterial line placement. We reviewed their medical records to assess their laboratory findings and clinical presentations. Results: All 4 patients met the 2013 ACR/EULAR criteria for systemic sclerosis and had a radial arterial line placement in the setting of invasive hemodynamic monitoring. Overall, 2 of 4 patients had arterial line placement during surgery; while 1 patient had it placed for invasive blood pressure monitoring during an ICU admission for renal crisis; and 1 patient had arterial line placement during cardiac resuscitation, but before administration of vasopressor support. In all, 3 of 4 patients had major ischemic events including digital gangrene, hand auto-amputation, and below-elbow amputation. Among all, 1 patient had temporary hand ischemia with recovery of perfusion with immediate arterial line removal within 24 hours. Conclusions: Radial arterial line placement may trigger critical ischemic events in scleroderma patients. This experience suggests that placement of radial lines needs to be thoughtfully weighed prior to insertion in patients with scleroderma, and alternative options should be carefully considered.",
keywords = "Arterial line placement, Raynaud's phenomenon, Systemic sclerosis, Vasculopathy",
author = "Julie Paik and Ram Hirpara and Heller, {Jennifer A.} and Laura Hummers and Fredrick Wigley and Ami Shah",
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AU - Hirpara, Ram

AU - Heller, Jennifer A.

AU - Hummers, Laura

AU - Wigley, Fredrick

AU - Shah, Ami

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AB - Objective: To demonstrate potential thrombotic complications after radial arterial line placement in patients with scleroderma. Methods: This is a retrospective case series of 4 patients with scleroderma who were hospitalized in the intensive care unit (ICU) requiring invasive hemodynamic monitoring and developed severe complications after radial arterial line placement. We reviewed their medical records to assess their laboratory findings and clinical presentations. Results: All 4 patients met the 2013 ACR/EULAR criteria for systemic sclerosis and had a radial arterial line placement in the setting of invasive hemodynamic monitoring. Overall, 2 of 4 patients had arterial line placement during surgery; while 1 patient had it placed for invasive blood pressure monitoring during an ICU admission for renal crisis; and 1 patient had arterial line placement during cardiac resuscitation, but before administration of vasopressor support. In all, 3 of 4 patients had major ischemic events including digital gangrene, hand auto-amputation, and below-elbow amputation. Among all, 1 patient had temporary hand ischemia with recovery of perfusion with immediate arterial line removal within 24 hours. Conclusions: Radial arterial line placement may trigger critical ischemic events in scleroderma patients. This experience suggests that placement of radial lines needs to be thoughtfully weighed prior to insertion in patients with scleroderma, and alternative options should be carefully considered.

KW - Arterial line placement

KW - Raynaud's phenomenon, Systemic sclerosis

KW - Vasculopathy

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