0
Communications to the Editor |

Brachial Artery Puncture for Blood Sampling Brachial Artery Puncture for Blood Sampling FREE TO VIEW

David J. Barnes, MB, BS, FCCP
Author and Funding Information

Affiliations: Royal Prince Alfred Hospital Sydney, Australia ,  Scott and White Clinic Temple, TX



Chest. 1999;115(5):1484. doi:10.1378/chest.115.5.1484
Text Size: A A A
Published online

To the Editor:

Recently, Okeson and Wulbrecht (September 1998)1 reported their experience with 6,185 brachial arterial punctures for arterial blood sampling, demonstrating a very low complication rate. Hematoma formation occurred in 4 patients (0.06%), immediate pain or paresthesias in 66 patients (1.1%), and delayed pain or paresthesias in 57 patients (0.9%). Of the few subjects who experienced immediate pain in the distribution of the median nerve, only one had discomfort that lasted > 48 h, and full resolution occurred within 2 months of the procedure. Only one subject with delayed pain or paresthesias had persistent symptoms, and again full resolution occurred within 4 months. Although the complication rates related to brachial artery puncture are low in this study, there is a risk of progressive median nerve damage, as demonstrated by the following example.

A 63-year-old man with chronic respiratory failure secondary to combined COPD and obstructive sleep apnea was admitted to the hospital in April 1997 with acute decompensation following a respiratory tract infection. Arterial blood gas sampling was successfully completed using the right brachial artery without immediate pain or paresthesias. Within 24 h, however, the patient complained of paresthesias in the median nerve distribution of the right hand. No hematoma was detected at the site of the brachial artery puncture, and spontaneous recovery over a period of weeks to months was predicted. However, the sensory symptoms persisted, and there was associated progressive muscle weakness and wasting in the distribution of the right median nerve.

Electromyographic and nerve conduction studies performed 6 months after the incident confirmed a severe lesion of the right median nerve with loss of 99% of axons. The sensory nerve action potential was absent, and the distal motor potential was < 2% of predicted. Eighteen months after the incident, the patient remains symptomatic with no clinical or neurophysiologic recovery of right median nerve function. A neurologic consultation suggested acute infarction of the median nerve as the most likely mechanism of nerve injury in this particular situation.

Hospital residency programs sometimes include recommendations to avoid sampling from end arteries, including the brachial artery, in order to avoid potential vascular complications. However, the risk of complications from brachial artery sampling, including median nerve damage, is poorly documented.23 Although the study by Okeson and Wulbrecht1 is somewhat reassuring, the case reported here demonstrates that significant morbidity can, in fact, occur from this seemingly innocuous medical procedure.

Correspondence to: David J. Barnes, MB, BS, FCCP, Department of Respiratory Medicine, Royal Prince Alfred Hospital, 100 Carillon Avenue, Newtown, New South Wales 2042, Australia; e-mail: dbarnes@nsw.bigpond.net.au

Okeson, GC, Wulbrecht, PH (1998) The safety of brachial artery puncture for arterial blood sampling.Chest114,748-751. [PubMed] [CrossRef]
 
Neviaser, RJ, Adams, JP, May, GI Complications of arterial puncture in anticoagulated patients.J Bone Joint Surg [Am]1976;58,218-220. [PubMed]
 
Berger, A Brachial artery puncture: the need for caution.J Fam Pract1989;28,720-721. [PubMed]
 

Brachial Artery Puncture for Blood Sampling

To the Editor:

Dr. Barnes provides a case report of an unfortunate individual who suffered a major median nerve complication following a brachial artery puncture for blood gas analysis. It is probably significant that the procedure was performed when the patient was in “acute decompensation,” although it is unclear if the patient was just in respiratory failure, or if there was also cardiovascular shock present. The reported findings seem most compatible with the diagnosis of infarction of the median nerve secondary to compromise of the vasa nervorum supplying the median nerve, in the absence of significant pressure from edema or hematoma—certainly a most unusual situation.

As pointed out in our article,1 the literature does suggest that complications may be more severe in subjects who are already in cardiovascular shock when the sample is obtained. Certainly, if Dr. Barnes’ subject was extremely hypoxemic at the time of the sampling, it would be reasonable to speculate that this might also contribute to the severity of the complication. Although his case emphasizes that it is possible to have a significant complication from a brachial artery puncture, our experience suggests that these events are extremely rare.

In our article, we stressed the importance of having brachial artery punctures performed by experienced technicians utilizing proper technique to minimize the chance of significant injury. We also stressed that complications may be more severe in the patient who has serious cardiovascular compromise—the exact situation where a brachial arterial puncture may appear to be the most convenient way to obtain samples for blood gas analysis.

Correspondence to: Gyman C. Okeson, MD, FCCP, Medical Director, Pulmonary Function Laboratory, Scott and White Clinic, 2401 South 31st Street, Temple, TX 76508

References
Okeson, GC, Wulbrecht, PH The safety of brachial artery puncture for arterial blood sampling.Chest1998;114,748-751. [PubMed] [CrossRef]
 

Figures

Tables

References

Okeson, GC, Wulbrecht, PH (1998) The safety of brachial artery puncture for arterial blood sampling.Chest114,748-751. [PubMed] [CrossRef]
 
Neviaser, RJ, Adams, JP, May, GI Complications of arterial puncture in anticoagulated patients.J Bone Joint Surg [Am]1976;58,218-220. [PubMed]
 
Berger, A Brachial artery puncture: the need for caution.J Fam Pract1989;28,720-721. [PubMed]
 
Okeson, GC, Wulbrecht, PH The safety of brachial artery puncture for arterial blood sampling.Chest1998;114,748-751. [PubMed] [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543