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LETTER TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 2  |  Page : 118-119
 

Leaking intravenous cannula due to malfunction of injection port valve


1 Department of Anesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India
2 Department of Onco-Anaesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi, India

Date of Web Publication28-Aug-2019

Correspondence Address:
Dr. Nishkarsh Gupta
Department of Onco-Anaesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_33_19

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How to cite this article:
Gupta A, Gupta N. Leaking intravenous cannula due to malfunction of injection port valve. Indian Anaesth Forum 2019;20:118-9

How to cite this URL:
Gupta A, Gupta N. Leaking intravenous cannula due to malfunction of injection port valve. Indian Anaesth Forum [serial online] 2019 [cited 2019 Nov 13];20:118-9. Available from: http://www.theiaforum.org/text.asp?2019/20/2/118/265650




Sir,

We report a rare complication related to placement of an intravenous cannula (IVC). A 6-month-old healthy 7.2 kg infant diagnosed with idiopathic clubfeet and was scheduled for a bilateral percutaneous tendoachilles tenotomy. Routine anesthesia monitors (electrocardiogram, pulse oximeter, noninvasive blood pressure, and temperature probe) were attached to the patient. Anesthesia induction was done using sevoflurane incremental technique (1%–8%). After achieving adequate depth of anesthesia for IVC placement, a 22-gauge cannula was secured over the dorsum of the left hand in single attempt. However, during its fixation, blood was noticed around the IVC. On close inspection, it was noticed that the blood was coming out from the injection port [Figure 1]. The IVC was removed, and the puncture site was properly dressed. Another IVC was secured at the cubital fossa of the same arm.
Figure 1: Leaking IV cannula with blood in the hub due to defective injection port valve

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Up to 40% of peripheral IVCs may be complicated by kinking, blockage, dislodgement, or infection.[1] However, leaking injection port of an IVC is an infrequent complication necessitating its replacement. Cannula failure often results in time-consuming and painful replacement of the peripheral IVC, which can be tricky, especially for children, when multiple limbs have to be operated, in elderly and in those with limb deformities/contractures or prolonged hospital stay. The only report of an injection port leakage in literature described it for an adult patient, and they also had replaced the IVC.[2] Securing an IVC can often be difficult and a very time-consuming procedure in children due to their very small veins, more so in chubby infants.[3] Intravenous access is usually secured in children after inhalational induction and any such difficulty in securing the IVC can prolong the induction period and increase the associated risks. The injection port backflow in our case was presumably due to malfunction of the one-way valve present inside it. Other cause of leakage from the injection port could be very high venous pressures. This can be due to proximal outflow obstruction to venous drainage from the extremity or venous pooling in the extremity.

Another option for management of this complication was replacement of the leaking IVC over a guidewire. A report of an 18-month-old Holt Oram syndrome child described use of a 23-gauge arterial catheter (Leader-Cath®) guidewire to exchange a leaking IVC with a fresh one.[4] In their case, the cannula was leaking at the junction of the shaft with the hub. However, we did not have a suitable guidewire to replace it and had to place it afresh. Also, using such a set to replace the IVC would involve significant costs.

The quality control unit of the manufacturing company should be notified of such an incident as was done in our case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wallis MC, McGrail M, Webster J, Marsh N, Gowardman J, Playford EG, et al. Risk factors for peripheral intravenous catheter failure: A multivariate analysis of data from a randomized controlled trial. Infect Control Hosp Epidemiol 2014;35:63-8.  Back to cited text no. 1
    
2.
Behura A, Ahuja M. A leaky intravenous cannula. Anaesthesia 2006;61:411.  Back to cited text no. 2
    
3.
Nafiu OO, Burke C, Cowan A, Tutuo N, Maclean S, Tremper KK, et al. Comparing peripheral venous access between obese and normal weight children. Paediatr Anaesth 2010;20:172-6.  Back to cited text no. 3
    
4.
Singh P, Kishore K. Guidewire replacement of leaking paediatric intravenous cannula. Indian J Anaesth 2016;60:70-1.  Back to cited text no. 4
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