Acute Arterial Ischemia in a Neonate: Complication of an Indwelling Radial Artery Catheter

AbstractA full-term newborn with perinatal depression, meconium stained liquor, shock, and hypoglycemic seizures was admitted at a hospital after 70 hours of life. He was ventilated, received antibiotics, and vasopressors. After 8 hours of left radial artery catheterization, ischemic changes appeared on tips of all the fingers of the newborn. The catheter was removed, and intravenous unfractionated heparin was started. Arterial Doppler revealed thrombus in both radial and ulnar arteries. The case was of category III (irreversible) acute arterial ischemia. Review Doppler after 4 days showed low resistance and dampened flow in radial and ulnar arteries. Surgical intervention was not done. Aspirin was given at discharge, and at 40 days, the distal end of the metacarpals was affected. The positive modified Allen’s test and close clinical monitoring did not guarantee the safety of radial artery catheterization. Other measures need to be critically evaluated to identify evolving thrombus early.