| Hematoma after withdrawal of needle | Bleeding or oozing at puncture site | Maintain firm pressure on site during withdrawal of catheter and for 5-15 minutes (as necessary) after withdrawal. | Continue to hold pressure to puncture site until oozing stops. |
| | Apply elastic tape firmly over puncture site. | |
| | For femoral arterial puncture sites, leave a sandbag or other device approved by hospital on site for 1-2 hours to prevent oozing. | Apply sandbag or other device approved by hospital to femoral puncture site for 1-2 hours after removal of catheter. |
| | If patient is receiving unfractionated heparin, discontinue 2 hours before catheter removal. | |
| Decreased or absent pulse distal to puncture site | Spasm of artery | Introduce arterial needle cleanly, nontraumatically. | Call provider to inject lidocaine locally and/or an approved lidocaine dose into arterial catheter. |
| Thrombosis of artery | Use 1 U of unfractionated heparin/1 mL IV fluid. | Arteriotomy and Fogarty catheterization may be needed both distally and proximally from the puncture site—results in return of pulse in > 90% of cases if brachial or femoral artery is used. |
| Bleedback into tubing or transducer | Insufficient pressure on IV bag | Maintain 300 mm Hg pressure on IV bag. | Replace transducer. “Fast flush” through system. |
| Loose connections | Use Luer-Lock stopcocks; tighten periodically. | Tighten all connections. |
| Hemorrhage | Loose connections | Keep all connecting sites visible. Observe connecting sites frequently. Use built-in alarm system. Use Luer-Lock stopcocks. | Tighten all connections. |
| Emboli | Clot from catheter tip into bloodstream | Always aspirate and discard before flushing. Monitor waveform for distortion (overdamping). | Remove catheter. |
| | Use continuous flush device. Gently flush < 2-4 mL. | |
| Local infection | Forward movement of contaminated catheter | Carefully secure catheter at insertion site. | Remove catheter. |
| Break in sterile technique | Always use aseptic technique. | Prescribe antibiotic if indicated. |
| Prolonged catheter use | Leave dressing in place until catheter is removed, changed, or dressing becomes damp, loosened, or soiled. | |
| Sepsis | Break in sterile technique | Use percutaneous insertion. Always use aseptic technique. | Remove catheter. |
| Prolonged catheter use | | Prescribe antibiotic if indicated. |
| Bacterial growth in IV fluid | Change IV fluid bag, stopcocks, transducer, and tubing every 72 hours. Do not use IV fluid containing glucose. Use a closed-flush system rather than an open-system. Carefully flush remaining blood from stopcocks after blood sampling. | |