At the beginning let me confess that although recommended we seldom seem to follow the MODIFIED ALLEN'S TEST before we start A-lines on radial arteries of patient
Now the case scenario
A 32 year old lady was taken over by us in the surgical ICU after a major laprotomy for catecholamine secreting tumour. Her pre-operative co-morbities included hypertension, LVH and severe anaemia. All of them were corrected to optimal levels
Anaesthesia consisted of GA/ CV supplemented by a thoracic epidural. Intra-operatively she had her IJV cannulated but was maintained on ANIBP for lack of transducing facilities.
Intra-op problems included need for vasodilators initially and later vasopressors/ inotropes including Noradrenaline and Dopamine. She also received massive blood transfusion to replace her loss
Post-operatively she was put on elective ventilation.
Day 2 when we took her over, she had signs of septicaemia, myocardial dysfunction and a host of multisystem problems and was still on the ventilator.
All standard treatment protocols were inititated and to permit repeated ABG analysis and also to monitor CO and other variables including Systolic Pressure Variation, it was decided to put the patient on VIGLEO the PICCO monitor of Edward Lifesciences.
As per requirement, her left Radial artery was cannulated using a 18G cannula using the regular tranfixation technique. ALLENS TEST NOT DONE. Procedure was uneventful and tracings on the A-line were good.
24 hours later patient's left hand distal to the A-line became discoloured, cold and clammy. A diagnosis of vascular insufficiency was made. Causes seem to be multiple, but definitely also included suspected insufficiency of the palmar arch, which was not tested..
A-line was removed. Vascular opinion confirmed vascular insufficiency and patient was put on Heparin
We eventually lost the patient to MOFS, but the blood flow to the affected limb did not improve.
NOW THE DILEMMA
A large number of papers are available that question the specificity and sensitivity of MODIFIED ALLEN"S TEST. All our Cardiothoracic surgery patients also do not have this test prior to their arterial cannulation
So do we need to perform it mandatorily
Although I did search I never found this out
What is the difference between ALLEN'S TEST and MODIFIED ALLEN'S TEST
Should this test be done only for arterial cannulation or also before we prick the artery for taking an ABG sample
Would leaving out this test and ending up with a very rare complication like this amount to negligence
Keenly looking forward to your inputs and experiences
regs
Now the case scenario
A 32 year old lady was taken over by us in the surgical ICU after a major laprotomy for catecholamine secreting tumour. Her pre-operative co-morbities included hypertension, LVH and severe anaemia. All of them were corrected to optimal levels
Anaesthesia consisted of GA/ CV supplemented by a thoracic epidural. Intra-operatively she had her IJV cannulated but was maintained on ANIBP for lack of transducing facilities.
Intra-op problems included need for vasodilators initially and later vasopressors/ inotropes including Noradrenaline and Dopamine. She also received massive blood transfusion to replace her loss
Post-operatively she was put on elective ventilation.
Day 2 when we took her over, she had signs of septicaemia, myocardial dysfunction and a host of multisystem problems and was still on the ventilator.
All standard treatment protocols were inititated and to permit repeated ABG analysis and also to monitor CO and other variables including Systolic Pressure Variation, it was decided to put the patient on VIGLEO the PICCO monitor of Edward Lifesciences.
As per requirement, her left Radial artery was cannulated using a 18G cannula using the regular tranfixation technique. ALLENS TEST NOT DONE. Procedure was uneventful and tracings on the A-line were good.
24 hours later patient's left hand distal to the A-line became discoloured, cold and clammy. A diagnosis of vascular insufficiency was made. Causes seem to be multiple, but definitely also included suspected insufficiency of the palmar arch, which was not tested..
A-line was removed. Vascular opinion confirmed vascular insufficiency and patient was put on Heparin
We eventually lost the patient to MOFS, but the blood flow to the affected limb did not improve.
NOW THE DILEMMA
A large number of papers are available that question the specificity and sensitivity of MODIFIED ALLEN"S TEST. All our Cardiothoracic surgery patients also do not have this test prior to their arterial cannulation
So do we need to perform it mandatorily
Although I did search I never found this out
What is the difference between ALLEN'S TEST and MODIFIED ALLEN'S TEST
Should this test be done only for arterial cannulation or also before we prick the artery for taking an ABG sample
Would leaving out this test and ending up with a very rare complication like this amount to negligence
Keenly looking forward to your inputs and experiences
regs