Radial neuropathy following arterial line removal: A rare complication from a routine ICU procedure

Abstract

Radial artery thrombosis is a rare complication of cannulation. There are no reported cases of acute thrombosis and severe acute neuropathy in the setting of cannula discontinuation. We report a case of acute radial nerve mono-neuropathy following thrombosis after radial arterial line removal. The thrombus was immediately evident on exam and diagnostic imaging after cannula discontinuation. The patient was consented and promptly taken to OR for immediate repair. Mild radial neuropathy persisted despite immediate repair. Immediate recognition of signs and symptoms is essential for diagnosis and management, especially in the high-risk population.

Keywords: Radial artery; radial artery line; radial neuropathy; thrombosis.

Figure 1.

Duplex ultrasound and Doppler evaluation of radial artery. Preoperative Doppler evaluation demonstrated normal flow in proximal and mid radial artery (a). Mid distal flow is decreased (b) and stops at thrombus (c). Radial artery beyond the wrist is fed through collaterals (d). Ipsilateral ulnar artery had normal flow (e); however, segmental pressure (f) demonstrated decreased wrist brachial index.

Figure 2.

Neurological exam of left-hand post repair. At 2-week postoperative follow-up, the wound is well healed (a). The patient still has weak wrist extension, finger extension at the metacarpophalangeal joint, and thumb extension (2/5 MRC) (b). Thumb adduction, abduction and flexion, finger, and wrist flexion were 4+/5, grasp +4/5, and forearm supination and pronation were intact. Sensation to pinprick and light touch in left hand was intact.