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Forearm extravasation injury during robot-assisted low anterior resection.

Kim JH, Park SS, Kim JC, Park JM, Byun SH - Korean J Anesthesiol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

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A 47-year-old female with an American Society of Anesthesiologists physical status of I was scheduled for robot-assisted low anterior resection and right hepatectomy... Her routine preoperative examination results were unremarkable... Considering that the operation was almost completed, we immediately stopped using the peripheral intravenous line to prevent extravasation injury... In the perioperative period, such injuries are often caused by nontoxic fluids; therefore, most extravasations do not cause severe damage, in contrast to cytotoxic injury in oncologic settings... As a result, physicians underestimate the consequences of extravasation injury in the perioperative period... In our report, although we had initially confirmed that the peripheral intravenous cannulations were functional, the function was compromised in the middle of the operation and eventually resulted in an extravasation injury... Use of the peripheral intravenous line had to be immediately stopped upon observation of evidence of extravasation or a related condition... Although we could not examine the catheter when extravasation was suspected, an inference could be drawn from other conditions, and we did not hesitate to stop using the suspicious peripheral line... Fortunately, the extravasation injury did not develop into other complications such as compartment syndrome, tissue necrosis requiring fasciotomy, or debridement... According to the checklist suggested by Bebaway et al., the intravenous line should be evaluated immediately after patient positioning by observing the gravity-induced free flow... In our case, dampening of the arterial pressure waveform and pulse oximeter reading was the first sign that we could suspect extravasation injury... The detection of extravasation injuries is especially difficult when the patient is under anesthesia and unable to communicate... Upon development of extravasation, immediate inspection and management are required to prevent further damage... In our report, the timely detection and management of the extravasation may have prevented more serious complications and thus improved the clinical outcome.

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Redness, skin abrasions, and bullae were observed on the ventral side of forearm once it was undraped post-operatively.
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Figure 1: Redness, skin abrasions, and bullae were observed on the ventral side of forearm once it was undraped post-operatively.

Mentions: Four hours later, both the arterial pressure waveform and the ipsilateral pulse oximeter reading were dampened. The monitoring devices and peripheral line flow were checked, and the peripheral line was not flowing smoothly. Because the intravenous line worked well initially and only malfunctioned later, we assumed that frequent changes in positioning might have affected the alignment or tightness of the catheter and arm-restraining device, potentially kinking or dislodging the catheter. Considering that the operation was almost completed, we immediately stopped using the peripheral intravenous line to prevent extravasation injury. A new pulse oximeter probe was applied to the patient's right ear. Because the dampening of the arterial cannulation appeared to worsen, noninvasive blood pressure was measured on the opposite arm. At the end of the procedure, the right forearm was undraped. The ventral surface of the arm was mildly swollen with bullae, redness, and skin abrasions, especially under the site of the arm-restraining device (Fig. 1). In contrast, the dorsal surface showed no abnormalities. Physical examination revealed palpable radial arterial capillary filling pressure with no sensory or motor defects. Following consultations with orthopedic and plastic surgeons, extravasation injury without compartment syndrome was diagnosed. Back-fluid was slowly aspirated from the cannula with a disposable syringe, and the catheter was carefully removed. The blisters were aspirated using 22-gauge needles under sterile conditions, and cold compression was applied.


Forearm extravasation injury during robot-assisted low anterior resection.

Kim JH, Park SS, Kim JC, Park JM, Byun SH - Korean J Anesthesiol (2014)

Redness, skin abrasions, and bullae were observed on the ventral side of forearm once it was undraped post-operatively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295974&req=5

Figure 1: Redness, skin abrasions, and bullae were observed on the ventral side of forearm once it was undraped post-operatively.
Mentions: Four hours later, both the arterial pressure waveform and the ipsilateral pulse oximeter reading were dampened. The monitoring devices and peripheral line flow were checked, and the peripheral line was not flowing smoothly. Because the intravenous line worked well initially and only malfunctioned later, we assumed that frequent changes in positioning might have affected the alignment or tightness of the catheter and arm-restraining device, potentially kinking or dislodging the catheter. Considering that the operation was almost completed, we immediately stopped using the peripheral intravenous line to prevent extravasation injury. A new pulse oximeter probe was applied to the patient's right ear. Because the dampening of the arterial cannulation appeared to worsen, noninvasive blood pressure was measured on the opposite arm. At the end of the procedure, the right forearm was undraped. The ventral surface of the arm was mildly swollen with bullae, redness, and skin abrasions, especially under the site of the arm-restraining device (Fig. 1). In contrast, the dorsal surface showed no abnormalities. Physical examination revealed palpable radial arterial capillary filling pressure with no sensory or motor defects. Following consultations with orthopedic and plastic surgeons, extravasation injury without compartment syndrome was diagnosed. Back-fluid was slowly aspirated from the cannula with a disposable syringe, and the catheter was carefully removed. The blisters were aspirated using 22-gauge needles under sterile conditions, and cold compression was applied.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 47-year-old female with an American Society of Anesthesiologists physical status of I was scheduled for robot-assisted low anterior resection and right hepatectomy... Her routine preoperative examination results were unremarkable... Considering that the operation was almost completed, we immediately stopped using the peripheral intravenous line to prevent extravasation injury... In the perioperative period, such injuries are often caused by nontoxic fluids; therefore, most extravasations do not cause severe damage, in contrast to cytotoxic injury in oncologic settings... As a result, physicians underestimate the consequences of extravasation injury in the perioperative period... In our report, although we had initially confirmed that the peripheral intravenous cannulations were functional, the function was compromised in the middle of the operation and eventually resulted in an extravasation injury... Use of the peripheral intravenous line had to be immediately stopped upon observation of evidence of extravasation or a related condition... Although we could not examine the catheter when extravasation was suspected, an inference could be drawn from other conditions, and we did not hesitate to stop using the suspicious peripheral line... Fortunately, the extravasation injury did not develop into other complications such as compartment syndrome, tissue necrosis requiring fasciotomy, or debridement... According to the checklist suggested by Bebaway et al., the intravenous line should be evaluated immediately after patient positioning by observing the gravity-induced free flow... In our case, dampening of the arterial pressure waveform and pulse oximeter reading was the first sign that we could suspect extravasation injury... The detection of extravasation injuries is especially difficult when the patient is under anesthesia and unable to communicate... Upon development of extravasation, immediate inspection and management are required to prevent further damage... In our report, the timely detection and management of the extravasation may have prevented more serious complications and thus improved the clinical outcome.

No MeSH data available.


Related in: MedlinePlus