Forum topic

The full reference is:

1.    Willsey D, Peterfreund R. Compartment syndrome of the upper arm after pressurized infiltration of infiltration of intravenous fluids. Journal of Clinical Anesthesia. 1997;9(5):428-430.
 

This is a case report of a trauma patient with a 16 g cath in the right AC infused with a pressure bag inflated to 150 mm Hg and a BP cuff on the same arm. The patient developed compartment syndrome and these competing pressures - the infusion and the compression from the BP cuff was thought to be the cause.

Unfortunately, I have never found any other studies. When you think about it, how would you set up such as study. Would you plan to do BPs on patients with infusions then assess the outcomes? Many researchers would shy away from doing such as study for ethical reasons. Since this case report is in the literature, there is some reason for concern. Obviously a regular infusion pump would be much less infusion pressure than the pressure bag at 150 mm HG but all of the literature on infiltration and extravasation state that an upstream obstruction (which would occur with the BP measurement) could cause overflow of the infusing fluid from the puncture site. With infiltration and extravasation being the leading cause of infusion-related lawsuits, it is not advisable to take BPs on an arm with infusions. But I am certain there are a few patients where you have no alternative. If that is the case, I would stop the infusion while taking the BP, but this would raise the issue of remembering to turn on the pump when the BP is done. And most of the time it is unlicensed aids taking the BP who should not be stopping or starting an infusion pump. This is one of those situations where the evidence in the forn of research is just not availabled. In these cases, all we have to rely upon is priniciples of anatomy, physiology of blood and physics of fluid flow. These principles should be considered as evidence also. Lynn