Management of an absent pulse following arterial catheterization

Arterial cannulation is a common procedure for diagnostic as well as interventional catheterisation. The incidence of arterial damage varies from around 1% to 45 % depending on the size of the patient, size of catheters used, repeat procedures, pre-existing vascular disease and whether the procedure was interventional as opposed to diagnostic (twelve times higher risk with intervention). The absence of a pulse following catheterisation can result from spasm, local thrombus formation, formation of a flap of endothelium, dissection or avulsion of the artery. In order to minimize the risks of arterial damage the following factors may help: a clean puncture, small French catheters, tapered well-fitting introducer sheaths, a short procedure time and administration of heparin (50 to 100 units/kg with further dose/s if the procedure lasts more than 75 minutes).