Absent radial pulse in ICU setting

Absent radial pulse in ICU setting

What possibilities are to be considered when a radial pulse is absent in a patient in the ICU:

  1. Aberrant radial artery – look for the aberrant artery pulsation in the ‘anatomical snuff box’ on the lateral aspect of the wrist near the base of the first metacarpal. The importance of recognizing the aberrant radial artery is that it can be mistaken for a vein and cannulated. Some medications which are to be injected into a vein, if given into the radial artery can lead to thrombosis and distal gangrene. It may be difficult to salvage the distal territory in spite of surgical venous grafting [1].
  2. Occluded radial artery due to previous trauma, aortoarteritis, embolic occlusion or peripheral vascular disease.
  3. Dissection of ascending aorta compromising the ostium of subclavian artery.
  4. Automatic inflation of non invasive blood pressure cuff occurring at the time of examination. Though it is a transient phenomenon, it can fool you sometimes in the ICU. The same applies to pulse oximetry tracings and SPO2 readings, if the sensor is kept on the same limb.

Reference

  1. Beale EW, Behnam A. Injection injury of an aberrant superficial radial artery requiring surgical intervention. J Hand Microsurg. 2012 Jun;4(1):39-42.