Variant Superficial Branch of Radial Artery along with Supplementary Tendons on the Dorsum of the Hand and Their Surgical Implications

Causes, risk factors, and complications of accidental intra-arterial administration of medications in a children's hospital: a case series

BACKGROUND

Accidental intra-arterial administration of a medication can lead to serious iatrogenic harm. Most studies have discussed single cases of accidental intra-arterial administration of a medication, but only a few have described multiple cases occurring in a single, pediatric hospital setting.

METHODS

The subjects were pediatric patients with an accidental intra-arterial administration of a medication. After obtaining approval from the institutional review board, the relevant cases were extracted from incident reports submitted to the patient safety office of the study center between November 2016 and April 2023.

RESULTS

A review of 18,204 incident reports yielded 10 cases (patient age: 27 days to 13 years) of accidental intra-arterial administration of a medication. The most common site of the cannulation was the dorsum of the foot followed by the dorsum of the hand. The medications administered were narcotics, sedatives, muscle relaxants, antibiotics, and crystalloids. No serious adverse events occurred after injection. In some cases, the accidental arterial cannulation was not discovered immediately (53 min to 26 days). Seven patients had difficult intravenous access; in two of these, ultrasound-guided peripheral venous cannulation was used.

CONCLUSIONS

We experienced 10 cases of accidental intra-arterial administration of a medication. The dorsalis pedis artery and the radial artery around the anatomical tobacco socket were common sites of unintentional arterial cannulation. Difficult intravenous (IV) access may be associated with unintentional arterial cannulation. If IV access is difficult or the free IV drip is sluggish, strict vigilance and repeated confirmation are needed to prevent unintentional arterial cannulation.

A Superficial Anatomical Variation in the Radial Artery Renders It Unsuitable as a Graft in Coronary Revascularization

In our experience, employing a radial artery in combination with an internal thoracic artery under specific conditions represents a superior option compared to using a vein graft in coronary artery surgery. Additionally, this combination is a remarkable alternative to utilizing bilateral thoracic arteries. We had planned the left radial artery as the second target graft in two patients undergoing coronary artery bypass surgery; the left internal thoracic artery to the left anterior descending branch would be the main graft in both patients. Anatomic variation of the radial artery, which presented as a superficial radial artery in both patients, led us to forego the use of the radial artery graft. This decision aimed to ensure sufficient blood supply to the palmar arch and prevent any potential inadequacy in the length of the coronary graft. The occurrence of this variation is exceptionally rare, accounting for approximately 0.02% based on our experience with radial artery harvesting. Furthermore, globally, the documentation of photographs depicting a superficial radial artery is even more infrequent.

An Extensile Approach to the Radial Aspect of the Carpus: "The Link Incision"

The structures on the radial side of the wrist and thumb base can be approached by a longitudinal incision on the radial side of the wrist. However, longer longitudinal scars can be cosmetically unacceptable and can result in a scar contracture. It is preferable to curve longer incisions along the Langer's skin lines to achieve better scar characteristics. Curving the incision also enables an extensile approach and provides easy access to the thumb base, radial carpus, and radial wrist joint. We describe our approach as a "Link" between the most common approaches that surgeons are familiar with; the dorsoulnar approach to the thumb metacarpophalangeal joint for ulnar collateral ligament repair and the flexor carpi radialis approach for distal radial fracture fixation. The zone between these two incisions is not as frequently approached. Our incision connects these two well established incisions and we have described a step by step approach to this unfamiliar area. This "Link zone" overlies the thumb trapeziometacarpal joint, scaphotrapeziotrapezoid joint, and the radial styloid. It contains superficial branches of the radial nerve, first extensor compartment tendons, and the deep branch of radial artery in the anatomic snuff box. The "Link incision" is an extensile approach in both the proximal and distal directions.

Radial Artery Injury with Attempted Intravenous Catheterization on the Dorsal Hand: A Case Report

Intravenous (IV) access on the dorsum of the hand is of high clinical significance. As it is possible for an arterial injury during IV access on the dorsum of the hand to occur, clinicians and healthcare providers should be cognizant of regional anatomy and anatomical variations during IV placement so as to prevent injuries to the radial artery. We report a case of an injury to the radial artery with an attempted hand IV placement in a cadaver and suggest possible ways to prevent this complication.