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Drep í fingrum í kjölfar ísetningar slagæðaleggja - sjúkratilfelli

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Authors
Atli Steinar Valgarðsson
Sigurbergur Kárason
Elín Laxdal
Kristín Huld Haraldsdóttir
Issue Date
2018-12

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Other Titles
Finger necrosis following arterial cannulation – a case report
Citation
Drep í fingrum í kjölfar ísetningar slagæðaleggja - sjúkratilfelli. 2018, 104(12): 551-553 Læknablaðið
Abstract
Inngangur: Notkun slagæðaleggja er algeng hjá gjörgæslusjúklingum vegna þarfar fyrir rauntímaupplýsingar um blóðþrýsting og vökva­ástand sem notaðar eru til að stýra meðferð ásamt því að vera notaðir til blóðsýnatöku. Alvarlegir fylgikvillar eru afar sjaldgæfir, en varanlegur blóðþurrðarskaði kemur fyrir hjá færri en 0,1% sjúklinga. Tilfelli: Hér er sagt frá sjúklingi í sýklasóttarlosti á gjörgæsludeild sem gekkst undir aðgerð vegna rofs á skeifugörn. Á annarri viku komu fram einkenni blóðþurrðar í öllum fingrum vinstri handar. Sjúklingurinn var fjölveikur, hafði þurft háa skammta af æðavirkum lyfjum og þurfti endurtekið að skipta um slagæðaleggi í mismunandi slagæðum, meðal annars í sveifarslagæð og ölnarslagæð vinstri handar. Beitt var blóðþynnandi meðferð sem sjúklingurinn þoldi ekki vegna blæðinga frá meltingarvegi og því dregið úr henni. Átta vikum síðar hafði afmarkast drep í öllum fingrum vinstri handar og í kjölfarið var framkvæmd aðgerð þar sem hluti af fingrum II-V voru fjarlægðir en ekki þurfti að gera aðgerð á þumli. Orsök drepsins er talin vera margþætt, meðal annars undirliggjandi ástands sjúklings, blóðsegi eða blóðþurrð í kjölfar ísetningar slagæðaleggja. Ályktun: Hér er lýst vel þekktum en mjög sjaldgæfum fylgikvilla slagæðaleggsísetningar og lögð fram tillaga að meðferðarferli sjúklinga með einkenni um blóðþurrðardrep í fingrum.
Arterial cannulation is a common procedure in critically ill patients, as it facilitates continuous monitoring of blood pressure, titration of inotropes, vasopressors and fluids and is also used for blood sampling. Serious complications from arterial lines are very rare, permanent ischemic damage occurs in less than 0,1% of patients. We report the case of a 60-year-old woman in septic shock caused by a perforated duodenal ulcer which was treated with emergent laparoscopic repair. She required high doses of vasopressors and received several arterial lines, including lines in both the ulnar and the radial arteries of the left arm. After two weeks in the intensive care unit she developed ischemia in all fingers of her left hand. She received anticoagulative therapy which was complicated by serious gastrointestinal bleeding and the therapy had to be discontinued. Eight weeks later she had demarcated necrosis in all fingers of her left hand and underwent partial amputation of fingers II-V, the thumb recovered without surgery. The cause of the necrosis was believed to be arterial embolism or ischemia secondary to arte- rial cannulations in combination with her underlying critical septic condition. Figure I. Gangrenous fingers of the left hand. The picture is taken almost 8 weeks after the onset of symptoms. Figure II . Flow chart for the treatment of suspected ischemia after cannulation of a peripheral artery. The flow chart is a proposal from an article published by Türker et al 2014. 7
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https://www.laeknabladid.is/tolublod/2018/12/nr/6895
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