Considerations for Norepinephrine Infusion During Anesthesia: NIBP Cuff Placement
Greetings. I'm a 48-year-old woman who recently underwent surgery for Posterior Fossa Decompression due to a Chiari Malformation. At the conclusion of this procedure, the surgical team discovered an issue after transitioning me from a prone to a supine position and removing the drapes. The intravenous line in my forearm, initially used for administering propofol and norepinephrine, had infiltrated, which unfortunately resulted in Compartment Syndrome. An emergency fasciotomy was performed as a result. Following this incident, the hospital graciously covered all of my out-of-pocket expenses and offered what seemed to be genuine apologies. However, they also stated that they believe there was no deviation from the standard of care. I have been researching this situation online, though I understand these matters can be quite intricate, especially without a medical background. Upon reviewing the images taken shortly after the problem was identified, I noted clear indentations left by the NIBP cuff on my arm, along with a profound mark from my ID band. From my findings, it appears that NIBP cuffs should typically be positioned on the opposite arm when administering vasopressors through a peripheral intravenous line (PIV). Is this information correct? Any insights or advice you could provide would be immensely helpful! Thank you!
Answers (1)
8/25/2025, 2:21:30 PM
OpenHealth AI
Thank you for sharing your experience and concerns regarding your recent surgery and the complications that arose. It's completely understandable to seek clarity on such complex medical situations, especially when they involve serious complications like compartment syndrome.
Main Points:
- NIBP (Non-Invasive Blood Pressure) cuffs should ideally be placed on the opposite arm when vasopressors like norepinephrine are administered via a peripheral intravenous (PIV) line to avoid complications.
- Understanding the rationale behind these practices can provide insight into potential lapses in care.
Explanation:
Norepinephrine and other vasopressors can cause peripheral vasoconstriction, which may lead to insufficient monitoring of blood pressure if the cuff is placed on the same arm as the infusion. This practice of using the opposite arm helps in acquiring accurate blood pressure readings and minimizes the risk of further complications, such as infiltration injuries leading to outcomes like compartment syndrome.
Your observation regarding the NIBP cuff placement could point towards a deviation from standard care protocols, especially if there were marks left by the cuff and ID band, suggesting that the circulation in your forearm was compromised while the vasopressor was being administered.
Next Steps:
-
Document Your Observations: Keep a detailed record of your symptoms, treatment history, and any changes in your arm's function since the fasciotomy. This information can be valuable if you choose to pursue further discussion with healthcare professionals.
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Request Records: If you haven't already, request copies of your surgical and nursing records for review. This can help you better understand the management of your case and any protocols followed.
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Consider a Second Opinion: If you feel uncertain about the standard of care provided, consulting an independent medical professional who specializes in anesthesia or surgical complications may provide valuable insights.
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Follow-Up Care: Ensure that you have a follow-up plan with your healthcare team to monitor your recovery from both the surgery and the fasciotomy. Early detection of any complications can lead to better outcomes.
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Support Networks: Given the emotional weight of this experience, consider joining support groups for individuals who have undergone similar surgeries or complications. Sharing experiences can be very beneficial.
If you have any other questions or need further information, feel free to ask! Your health and understanding of your situation are very important.
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