MX OF PULSE LOSS
• In the case of diminished or absent pulses
• Starting a heparin infusion 2-3 hours after the procedure The initial treatment
consists of heparin 100 U/kg as a single stat dose, followed by an infusion of
• If the pulses have not normalized the next 24hrs. an intravenous
streptokinase infusion is started.
• In small patients (less than 12 kg), if there is no return of pulses in another 24
hours but no threat of tissue loss, no surgical intervention be undertaken
because of the difficulty of repairing these small vessels.
• Streptokinase: Initial bolus 1000 units/kg followed by an infusion of 1000 units/kg/hr.
• rTPA Regime 1 Initial bolus of 0.7 mg/kg followed by an infusion of 0.2 mg/kg/hr.
• rTPA Regime 2 Infusion 0.1 to 0.5 mg/kg/hr (incremental increase of 0.1 mg/kg/hr).
• End Points
• Return of pulse.
• Bleeding at entry site.
• Internal bleeding e.g. haematemesis, melaena, cerebral haemorrhage,
• If no response after 6 hours or if clinical deterioration
• the rate of vascular complications occurring after intervention procedures has
been reported to be 3 to 6 times higher than in diagnostic procedures despite
• However, another study found that there were no arterial complications in
children as long as the ACT was maintained above 200 seconds.
• It was also reported that the incidence of arterial complications rose from
5.2% to 12.9% in patients < 5 kg as the arterial sheath size increased from 4F
to 5F. It rose further to 42.8% when the size increased to 6F
• Younger children, longer procedure times, and difficult access more prone thrombosis.
• Use of low profile balloon/ double balloon
• Proper training of the staffs for sheath removal
• Early institution of heparin in small infants
• Judicious use of vasodilators
• USG guided access
• Surgical back-up