Category: Intravenous and Fluid Therapy

Inadvertent Arterial Cannulation

Question#: 549

Question:

In the event of known/suspected arterial cannulation while attempting intravenous cannulation, what course of action is most appropriately prehospital? Especially in the situation the catheter is in situ and saline locked?

Answer:

Inadvertent arterial cannulation should be suspected when:
* Cannulation in an area where an artery is in close proximity to a vein
* Blood that is bright-red in appearance
* Blood pulses in the IV line (this may only be seen after the ligature/tourniquet is removed)
* Appearance of too much blood from the cannula
* Intense pain or burning at the site

Actions to take if inadvertent arterial cannulation is suspected:
1. Immediately stop the administration of fluids or medications.
2, Remove any dressings over the cannula.
3. Clean the area with an alcohol swab.
4. Put on a clean pair of gloves.
5. Place sterile gauze over the insertion site and gently pull cannula out.
6. Apply and maintain pressure slightly above the insertion site, for a minimum of 5 minutes after bleeding has stopped; elevation may be used.
7. Inspect the cannula; if broken:
    7.1 Occlude blood flow with a tourniquet or direct pressure above site
    7.2 Place the patient in the Trendelenburg position (left side, head down)
    7.3 If the cannula piece is felt in the artery apply direct pressure to prevent movement of it
8. After bleeding has stopped, cover with a clear dressing, so that re-bleeding can be seen
9. Report the inadvertent arterial cannulation to the hospital so that they can monitor the patient and manage infection risk

References
Alvi, N.I. (2008). Its only a cannula!! British Journal of Anaesthesia, accessed 03-Nov-2021
Prabhu, R., et al (2014). Be Careful with an IV Line. Journal of Clinical & Diagnostic Research, accessed 03-Nov-2021
Critical Care Trauma Centre. Procedure: Removal of a Peripheral Arterial Line. London Health Sciences Centre, accessed 03-Nov-2021, https://www.lhsc.on.ca/critical-care-trauma-centre/procedure-removal-of-a-peripheral-arterial-line

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