Description of Event or Problem · 0
PHYSICIAN REPORTED DIFFICULTY WITH COMMON FEMORAL ARTERY (CFA) ACCESS, DURING A TRAUMA CASE, WHICH CONTRIBUTED TO ISCHEMIA OF THE LIMB REQUIRING A FASCIOTOMY. A PATIENT SUSTAINED A PELVIC FRACTURE DUE TO A FALL. THE PATIENT ARRIVED AT THE HOSPITAL WITH AN SBP OF 70 MMHG AND SIGNS OF HEMORRHAGIC SHOCK. A PELVIC BINDER WAS APPLIED TO THE PATIENT. THE DECISION WAS MADE TO USE A REBOA CATHETER. THE NEEDLE, FROM A PRYTIME REBOA CATHETER CONVENIENCE KIT, ENTERED THE CFA AT A 70° ANGLE RATHER THAN THE IDEAL 45° ANGLE, DUE TO MECHANICAL OBSTRUCTION OR INTERFERENCE FROM THE PELVIC BINDER. THE PHYSICIAN CONSIDERED THE ACCESS ANGLE AS THE PRIMARY FACTOR CONTRIBUTING TO THE LIMB ISCHEMIA WHICH RESULTED IN A FASCIOTOMY. ANOTHER POSSIBLE CONTRIBUTING FACTOR TO THE LIMB ISCHEMIA WAS THE 7FR INTRODUCER SHEATH BEING LEFT IN PLACE IN THE VESSEL, AFTER CATHETER WAS REMOVED, FOR ~2 HOURS. THE NEEDLE USED TO GAIN ACCESS TO THE CFA AND THE 7FR INTRODUCER SHEATH ARE MANUFACTURED AND LABELED BY OEMS AND INCLUDED IN PRYTIME'S CONVENIENCE KIT. THERE WAS NO REPORTED FAILURE OR DEFICIENCY WITH THE NEEDLE OR 7FR INTRODUCER SHEATH.