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Commentary: Kinked Catheter Unravelment in the Right Upper Extremity: An Unconventional Solution
The Maimonides Medical Center team presents a case of a kinked radial catheter in an elderly man with significant shoulder vessel tortuosity. Several considerations to avoid such a problem should be remembered. For short people (5'5") or under, we recommend left radial access. Even with left radial access, a catheter may kink. Given the tortuous path and visualization of the loop, the operators should be aware that vigorous manipulation will likely produce a kink, heralded by the loss of aortic pressure signal. Furthermore, when torquing the catheter produces no response in such a tortuous vessel, the operators may consider inserting a guidewire (before the kink occurs) and torque with the guidewire in place to move catheter toward the target area. However, once the kink has occurred, do not pull it into the arm to try to unkink it.
There are several ways to unkink the catheter once lodged in the brachial artery. These include obtaining alternate arterial access, snaring the catheter centrally, and retracting it. Another way would be to lock the catheter into the brachial artery, as in this case, with either a blood pressure cuff inflated to high pressure, then unkink the catheter, or compress the artery in the manual mode, as was done here.
We should all consider the radiation exposure needed with the last maneuver and whether full-time fluoroscopy for the unkinking maneuver is needed.
The team did the right thing to help the patient at the risk of more radiation. The technologist (and team) might check his radiation badge for this quarter and see if he can proceed to work close to the tube or will need to move to the circulatory position for a while.
