Question 3 of 14

(demo test)

The image demonstrates a sheared arterial catheter. Shearing of catheters used for epidural, venous, and arterial access is rare, but well-described in the literature. Repeated patient wrist movements, re-insertion of the needle introducer into the catheter, and transection during suture removal/placement are some reported causes. 

The primary concern with a retained intra-arterial catheter fragment is distal embolization, leading to digit/limb ischemia and necrosis. Proximal embolization is much more rare, and may occur with distal vasospasm. Bedside or operative retrieval is therefore the most appropriate choice.

If there are signs of infection, secondary antibiotics may be indicated. Anticoagulation may be secondarily indicated with signs of spasm/ischemia. Observation is inappropriate, unless  perhaps the catheter is demonstrably extra-vascular.

references:

Bedside retained radial artery catheter removal in a hemodynamically unstable neurocritically-ill patient: a case report.