Avoiding iatrogenic thrombo-embolism: the "KAPLIT" technique
© Chaudhary et al; licensee BioMed Central Ltd. 2010
Received: 19 July 2010
Accepted: 13 October 2010
Published: 13 October 2010
In patients with traumatic injury of an upper limb it is often necessary to both secure intravenous (IV) access and record blood pressure noninvasively in the other upper limb. This may cause intermittent obstruction to the flow of IV fluids during cuff inflation. Also backflow of blood into the IV tubing when the cuff is inflated and the temporary stasis which occurs predisposes to clotting of blood in the IV tubing/catheter. Overenthusiastic efforts to push IV fluids without disconnection and flushing of IV line may pose a possible risk of embolizing the clotted blood thrombus into circulation. We describe a simple technique to prevent backflow of blood into the IV tubing when both intravenous fluid infusion and non-invasive blood pressure cuff are in the same limb. This may prevent clot formation and eliminate the risk of an iatrogenic thrombo-embolism.
Patients presenting to the emergency department with multiple trauma often require aggressive fluid resuscitation and constant monitoring of their arterial blood pressure. In patients in whom one upper limb is already compromised as a result of trauma both intravenous (IV) fluid infusion and non-invasive blood pressure (NIBP) monitoring have to be done in the other upper limb. IV line placement in the lower limbs is generally avoided because of associated increased risk of thrombophlebitis. Also, the appropriate size thigh cuff for NIBP may not be available especially in the emergency department where such cases often present.
NIBP monitoring has long been considered to be a safe monitoring method. Underreporting of the complications associated with NIBP monitoring has lead to limited awareness among clinicians of its potential complications . The reported complications with its use include petechial rash, ecchymoses, skin necrosis, infection, thrombophlebitis, venous stasis, compressive neuropathy and compartment syndrome . Although the incidence of iatrogenic thrombo-embolism resulting from embolization of clot formed in IV tubing due to venous stasis with NIBP measurement has not been reported, the potential risk still exists as described. This risk of iatrogenic thrombo-embolism may be very small, but its prevention cannot be over-emphasized when compared to the morbidity and mortality when such a complication occurs apart from the time and resources consumed especially when a simple technique (the "KAPLIT" technique) can be used.
KC- Senior Resident, Department Of Anaesthesia and Intensive Care, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India
LG- Ex-DNB Student, Department Of Anaesthesia and Intensive Care, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India
RA- Director, Professor and Head, Department Of Anaesthesia and Intensive Care, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India
non invasive blood pressure.
Dr. Anju R Bhalotra, Professor, Department of Anaesthesia, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi
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