Defective arterial catheter: Potential for catastrophic complication?

Sir,

Complications due to defective manufacture design or products are not rare in medical practice. We experience yet another unique problem with the use of a defective arterial cannula due to manufacturer related problem.

A 30-year-old patient having extra hepatic portal vein obstruction was posted for leno-renal shunt. After induction of anesthesia, an arterial line was planned for invasive blood pressure monitoring. A 20 G arterial cannula (Arterial LEADER CATH (PE), Vygon Ref 115.090, 3Fr- L.8 cm-0.9 mm-24 ml/min) was inserted in the left radial artery using the Seldinger's technique. After threading the catheter and removal of the guide-wire, the catheter was attached to the pressure tubing. Immediately, after releasing the extension at the wrist, a pulsatile blood flow was noticed at the junction of the hub of the catheter, just proximal to the insertion point. The artery was compressed proximally to stop bleeding. On careful examination, it was found that the catheter was detached from the hub and only a small segment of the catheter was visible outside the skin and the catheter was held with an artery forceps and was removed carefully. Puncture site was compressed for 5 min for preventing any hematoma formation. After removal of the cannula, it was observed that the connection between the catheter and anti-kink collar (attached with the hub) was loose, leading to detachment during the wrist movement [Figure 1].

Figure 1

Defective arterial catheter

Though, our patient did not have any significant morbidity, this defective catheter had the potential for serious complications such as catheter migration and blood loss. If found unnoticed this can lead to significant blood loss within a small span of time, especially in children and anemic patients. The probability of intra-arterial catheter migration leading to blockade of the artery in the peripheral circulation cannot be ruled out. Incidences of catheter fracture and migration have been reported with central venous catheters.[1] Similarly, detachment of the introducer needle from its hub during internal jugular vein cannulation has been reported.[2]

Such problem in the manufacture of catheters should not be ignored and should be reported as it has a potential for catastrophic complications. The catheter should be carefully observed and checked for its integrity before attempting cannulation.