Access Complications and Management

Abstract

Haemostasis complications of the puncture site are the last thing we want to hear about. This could mean that the procedure is not over yet or that the risk has only shifted from a place to another.

Despite all efforts, these complications may still happen. One to two hours after the end of the procedure, and at regular follow-up visits, basic clinical examination of the thigh can depict early stages of failed haemostasis of the vascular access site.

Abnormal pain in the groin, tenderness, tumefaction, systolic-diastolic femoral bruit, skin tension and thigh or leg oedema are signs that should trigger further investigation procedures.

More advanced situations include cyanosis of the limb, thigh tension and even sensitive or motor neurological deficiency of the leg. In more severe untreated cases, compartment syndrome could occur, as well as skin necrosis at the thigh secondary to persistent tension.

Ultrasound examination of the vascular access area is a simple diagnostic test. It can be performed immediately at the patient’s bedside. Conservative treatment is usually sufficient, but in rare cases, surgery or endovascular treatment may be needed.