Anesthetic Complications: Vascular Cannulation

VASCULAR CANNULATION

Claims related to central venous access in the ASA database were associated with patient death 47% of the time and represented 1.7% of the 6449 claims reviewed. Complications secondary to guidewire or catheter embolism, tamponade, bloodstream infec-tions, carotid artery puncture, hemothorax, and pneu-mothorax all contributed to patient injury. Although guidewire and catheter embolisms were associated with generally lower level patient injuries, these com-plications were generally attributed to substandard care. Tamponade claims following line placement were often for patient death. The authors of a 2004 closed claims analysis recommended reviewing the chest radiograph following line placement and repo-sitioning lines found in the heart or at an acute angle to reduce the likelihood of tamponade. Brain damage and stroke are associated with claims secondary to carotid cannulation. Multiple confirmatory methods should be used to ensure that the internal jugular and not the carotid artery is cannulated.

Claims related to peripheral vascular can-nulation in the ASA database accounted for 2% of 6849 claims, 91% of which were for complications secondary to the extravasation of fluids or drugs from peripheral intravenous catheters that resulted in extremity injury (Figure 54–4). Air embolisms, infections, and vascular insufficiency secondary to arterial spasm or thrombosis also resulted in claims. Of interest, intravenous catheter claims in patients who had undergone cardiac surgery formed the largest cohort of claims related to peripheral intrave-nous catheters, most likely due to the usual practice of tucking the arms alongside the patient during the procedure, placing them out of view of the anesthe-sia providers. Radial artery catheters seem to gen-erate few closed claims; however, femoral artery catheters can lead to greater complications and potentially increased liability exposure.