Number of hand compartments1/13/2024 For reversal, 60 mg of intravenous protamine was administered. During the procedure, the patient received a total of 28,000 units of intravenous heparin, which maintained his activated clotting time between 299 and 395 seconds. The ablation procedure lasted approximately five hours. However, the actual duration of applied pressure was not specified. After each failed attempt at cannulation of the right radial artery, pressure was applied directly over the artery access site. Five additional attempts were made on the right before turning to the left radial artery, which was ultimately cannulated. Prior to the procedure, attempts to place a right radial arterial catheter were made, but failed. Preprocedure vitals and laboratory investigations were as follows: blood pressure was 141/89 mm Hg, heart rate was 114 beats per minute, temperature was 36.5☌, respiratory rate was 18 breaths per minute, oxygen saturation was 97%, the international normalized ratio 1.17, a physical performance test of 30.4 seconds, and a platelet count of 284 x 10 9 per L. The prasugrel was continued due to the history of mitral valve replacement. In anticipation of the procedure, the patient discontinued his aspirin five days prior to the ablation and the apixaban was held the morning of the procedure. The patient’s daily medications included oral apixaban, aspirin, prasugrel, fenofibrate, rosuvastatin, metoprolol, amlodipine/olmesartan, diltiazem, metformin, and sotalol. He underwent a radiofrequency catheter ablation procedure to control the atrial fibrillation four months previously, but this procedure was unsuccessful the plan for this hospitalization was a repeated attempt at ablation to correct the persistent atrial fibrillation. The patient, a 60-year-old Caucasian male, had a past history of coronary artery disease, atrial fibrillation, and mitral valve replacement. The goal of our case report is to highlight the negative consequences of radial artery injury. We present a case of compartment syndrome that developed after multiple unsuccessful attempts at placing a radial arterial line. Hematoma formation from arterial injury during arterial access or after catheter removal is uncommon, but can have significant consequences if compartment syndrome develops. Radial artery cannulation for hemodynamic monitoring and coronary procedures is becoming more common at our institution. Much less commonly, forearm compartment syndrome can be caused by high-voltage electrical injury, snake bites, arterial cannulation in critical care monitoring, 2, 3 intravenous line extravasation, 4 and illicit drug injections. Reperfusion injury after restoration of blood flow into, or out of, the forearm following prolonged tissue ischemia is also a common cause of compartment syndrome. Hematoma formation from vascular injury associated with the trauma adds volume to the compartment and subsequently increases pressure. Forearm compartment syndrome occurs most commonly after extremity trauma 1 that results in significant intracellular edema within muscle that is confined by non-yielding fascial compartments. Missed or untreated forearm compartment syndrome has severe consequences, including paralysis, loss of sensation, and muscle infarction, which leads to contracture. Key WordsĬompartment syndrome, forearm, arterial cannulation, hematoma Case Description Often, nonsurgical maneuvers can be implemented to prevent compartment syndrome if initiated early enough.7 Most importantly, it is necessary to promptly identify impending compartment syndrome so that surgical intervention can either be prevented or initiated to help preserve extremity sensory and motor function if compartment syndrome develops. There has been an increased incidence of forearm compartment syndrome after radial artery cannulation. Surgical treatment of compartment syndrome, even if performed prior to permanent nerve and muscle damage, is associated with significant morbidity. Missed or untreated forearm compartment syndrome has devastating functional consequences resulting in varying degrees of sensory and motor loss in the affected extremity. We have concluded that early diagnosis of compartment syndrome can help avoid permanent damage to nerve, muscle, and hand function. We present a case that highlights the morbidity of forearm compartment syndrome, how to diagnose increasing compartment pressures early, and a simple technique to halt continued bleeding into the forearm compartments in an attempt to minimize the likelihood of developing compartment syndrome. Often, multiple failed attempts have been made to access the radial artery prior to successful cannulation or abortion of the procedure. At our institution, we have seen a recent increase in the number of requests to evaluate patients with possible forearm compartment syndrome after arterial cannulation or percutaneous cardiac interventions.
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