From the Research
When the initial flash of blood ceases to fill the flash chamber during arterial catheter insertion, you should immediately stop advancing the catheter and reassess your position by slightly withdrawing the needle and catheter together as a unit, then carefully redirect and advance slowly until blood flow returns. This approach is crucial to avoid complications such as arterial injury, thrombosis, or hematoma formation, which can significantly impact patient morbidity, mortality, and quality of life 1, 2, 3. The provided evidence, although not directly addressing the specific scenario of an initial flash of blood ceasing to fill the flash chamber, emphasizes the importance of proper technique and the potential risks associated with arterial catheterization, including thrombosis and hematoma formation 4, 5. Key considerations during the procedure include maintaining a shallow angle of approach and ensuring the patient's wrist is properly positioned and stabilized if using the radial artery. If blood flow does not resume after reassessment and redirection, it is recommended to remove the device completely, apply pressure to the site to prevent hematoma formation, and then attempt insertion at a different site. Never forcing the catheter forward without blood return is critical to prevent damage to the vessel or creation of a false lumen, which can lead to severe complications. Given the potential for significant morbidity and mortality associated with arterial catheter complications, prioritizing caution and adhering to best practices in catheter insertion techniques is essential.