Overview
Infection of puncture wounds, particularly those involving arterial punctures during procedures like PICC insertion or arterial access, can lead to serious complications including pseudoaneurysms, nerve compression, and arteriovenous fistulas. These complications may manifest delayed after the initial injury 13.Diagnosis
Clinical Presentation: Paresthesia, pain, swelling, or signs of infection at the puncture site 1.
Imaging: Ultrasound is crucial for diagnosing pseudoaneurysms and assessing vascular complications 13.
Doppler Ultrasound: Useful for detecting arteriovenous fistulas and assessing blood flow abnormalities 3.Management
Surgical Intervention: Open surgery may be required for treating pseudoaneurysms causing nerve compression or significant vascular damage 1.
Ultrasound-Guided Procedures: For pseudoaneurysms, ultrasound-guided thrombin injection or covered stent placement can be effective 3.
Arterial Sheath Removal: Internal balloon tamponade can safely remove accidentally placed arterial sheaths without significant blood loss 2.Special Populations
Pregnancy: Active surveillance ultrasound post-unsuccessful PICC insertion is recommended to prevent late complications 1.
Comorbidities: No specific recommendations provided for pediatrics or elderly populations in the abstracts; focus remains on prompt diagnosis and intervention 123.Key Recommendations
Active Surveillance Ultrasound: Perform ultrasound surveillance within 24-48 hours following unsuccessful PICC insertion attempts to detect and manage potential late complications (Evidence: Moderate 1).
Imaging for Diagnosis: Utilize ultrasound and Doppler ultrasound for diagnosing vascular complications such as pseudoaneurysms and arteriovenous fistulas (Evidence: Moderate 13).
Surgical or Ultrasound-Guided Treatment: Consider surgical intervention or ultrasound-guided procedures like thrombin injection for managing pseudoaneurysms (Evidence: Weak 13).References
1 Antunes BF, Machado AM, Miziara RA, Liao AW, Mendes CA, Wolosker N et al.. Late neurological deficit after attempted PICC insertion in the arm. The journal of vascular access 2019. link
2 van Dijk RB, den Heijer P, de Muinck E, Lie KI. Internal balloon tamponade: a non-surgical method for removal of accidentally placed sheaths from the subclavian artery. Catheterization and cardiovascular diagnosis 1993. link
3 Rapoport S, Sniderman KW, Morse SS, Proto MH, Ross GR. Pseudoaneurysm: a complication of faulty technique in femoral arterial puncture. Radiology 1985. link