Volkman’s Contracture, Persistent Limb Ischaemia, and Amputation: A Complication of Brachial Artery Catheterisation for Haemodynamic Monitoring Using PiCCO

Author:

Bagga Veejay1,Palmer Marion1,Sadasivan Ramesh1,Raghuraman Govindan1

Affiliation:

1. Department of Intensive Care Medicine, Birmingham Heartlands Hospital, Apartment 31, Queens View, 88 Park Grange Road, Sheffield, S2 3RY, Birmingham B9 5SS, UK

Abstract

We report a case of a 64-year-old woman who was admitted to intensive care unit with multiorgan failure secondary toPlasmodium falciparummalaria. Haemodynamic monitoring using the transpulmonary thermodilution with pulse contour analysis system (PiCCO) was achieved via the left brachial artery. Two days later, a flexion deformity of the left hand was noted, and examination revealed left lower arm ischaemia. Removal of the catheter resulted in an immediate improvement of the contracture. However, distal pulses were still absent, and the arm remained ischaemic resulting in a below elbow amputation. This is the first documented case of a persistent limb ischaemia following the insertion of an arterial catheter for haemodynamic monitoring with PiCCO. We therefore highlight the need for regular assessment of limb perfusion after arterial catheterisation for haemodynamic monitoring with PiCCO. In addition, the brachial artery should be avoided, and femoral artery catheterisation is recommended.

Publisher

Hindawi Limited

Subject

Critical Care and Intensive Care Medicine

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