Petechial and subcutaneous hemorrhage with blister formations in right upper extremity during cardiopulmonary bypass by axillary artery cannulation

A 72-year-old man underwent aortic valve replacement and coronary artery bypass graft. He was a maintenance hemodialysis patient and had a dialysis arterial venous shunt in the left forearm. Peripheral venous catheter 24G was already placed in the right forearm, and central venous catheter and pulmonary artery catheter were inserted in the right jugular vein before induction of anesthesia. Noninvasive blood pressure cuff was not used since arterial line was already placed in left femoral artery. Most intraoperative transfusion or agents were given via central venous catheter. Cefazolin 1 g with 100 ml of normal saline and about 300 ml of normal saline were given via peripheral venous catheter during operation, and intravenous fluid via peripheral venous catheter was stopped after induction of cardiopulmonary bypass. Cardiopulmonary bypass with right axillary artery cannulation bypass was established due to severe calcification of ascending aorta. The waveform and saturation of pulse oximeter in the right thumb were normally displayed after weaning from cardiopulmonary bypass. When drapes on patient were removed, petechial and subcutaneous hemorrhage with blister formations were found in right upper extremity (Fig. 1a) and subcutaneous hemorrhage was most severe around the cannulation site of peripheral venous catheter (Fig. 1b). Acute compartment syndrome was diagnosed from these findings.