On the Safety of Radial Artery Cannulation

A case of complex regional pain syndrome type II after transradial coronary intervention

“…To our knowledge, no CRPS type II or nerve injury has been reported in association with radial artery puncture. On the contrary, a number of reports support the safety and usefulness of the procedure [7,8], whereas it has been shown that venipunctures may cause CRPS type II [9].…”

Transradial coronary intervention without pre-screening for a dual palmar blood supply

“…Allen did not define the test result as positive or negative nor did he give a time limit to achieve maximal palmar blush after discontinuation of ulnar artery compression. The test has been modified over the years and further refined by graded responses of normal, less than normal, and absent collateral circulation [2]. The upper limit for a "normal" response is variable with recommendations anywhere between 5 and 15 s. This undefined time interval, together with the subjective interpretation, limits the diagnostic usefulness of the test.…”

“…In anaesthesiology however, radial artery cannulation for haemodynamic monitoring is routinely performed without assessing collateral ulnar arterial flow. Despite a 25% incidence of radial artery occlusion amongst patients following long-term intensive care treatment, this practice is not associated with vascular complications [2]. We propose that pre-screening for a dual palmar blood supply is not necessary, and the presence of a palpable radial pulse is sufficient to allow successful radial artery cannulation without subsequent neurovascular complications.…”

Multiple Digital Gangrene after a Radial Artery Penetrating Injury: A Case Report

“…Almost all of the reported cases have been patients who have undergone percutaneous cannulation of the radial artery (PCRA). [4][5][6][7][8][9][10][11][12][13][14][15] This is a common procedure in intensive care units to monitor blood pressure and take frequent blood samples, as well as to insert guiding catheters for coronary angioplasty. 16 The cause of digital gangrene is usually thromboembolic occlusion of the radial artery or the superficial palmar arch.…”

“…After cannulation, 27.5% of patients develop abnormal radial artery flows, with 10% having absent pulses but none having any symptoms of hand ischemia. 20 Slogoff et al 7 prospectively examined radial artery flow after decannulation by Doppler in 1,699 patients and found partial or complete radial artery occlusion after decannulation in >25% of patients. However, no ischemic damage or disability of the hand occurred in any patient.…”