Indigo carmine extravasation from intravenous injection caused by a blood pressure cuff

Sep 29, 2026

Uploaded by Jacob

Indigo carmine is often used intravenously to verify ureteral patency, but a case report describes distal extravasation occurring after administration into a forearm vein during temporary blood flow occlusion by a proximal cuff on the same side. A 69-year-old woman receiving medications through bilateral forearm catheters developed blue dye leakage along distal vessel courses beyond the cuff and beyond the venous insertion site. Pigment resolved within about one day and no surgical-field dye leakage was seen. The authors discuss how brief cuff-based blood pressure measurements can still pose extravasation risk and highlight implications for anesthesiology practice.

LanguageEnglish

CategoryHealthcare

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Indigo carmine extravasation from intravenous injection caused by a blood pressure cuff

Letter to the Editor / Case report background

Procedure and clinical course

Discussion: mechanisms and clinical implications

Acknowledgments and author contributions

Sekiguchi et al. JA Clinical Reports (2026) 12:1 [https://doi.org/10.1186/s40981-025-00835-3](https://doi.org/10.1186/s40981-025-00835-3) JA Clinical Reports LETTER TO THE EDITOR Open Access Indigo carmine extravasation from intravenous injection caused by a blood pressure cuff Masaya Sekiguchi 1, Jun Honda 1*, Atsuyuki Hosono 1 and Satoki Inoue 1 Keywords Indigo carmine, Extravasation, Temporary blood flow occlusion, Cuff To the Editor, Intravenous administration of indigo carmine is commonly used to confirm the presence or absence of ureteral obstruction or injury. We here report a case of indigo carmine extravasation distal to the tourniquet site, which resulted from administration into a forearm vein during temporary blood flow occlusion by a proximal cuff applied on the same side. A 69-year-old woman (157 cm, 36 kg) underwent an abdominal total hysterectomy with bilateral salpingooophorectomy for an ovarian tumor under general anesthesia. A blood pressure cuff was applied to her right upper arm, and blood pressure was measured at 5-minute intervals during the procedure. Two IV catheters were inserted, one into each forearm, and a check valve was attached to the 18-G IV catheter in the right forearm. Remifentanil and phenylephrine were administered continuously via the left forearm catheter, while other medications were administered intermittently via the right forearm catheter. During surgery, ephedrine, phenylephrine, and rocuronium administered intermittently via the peripheral venous line in the right arm were smoothly infused and produced their intended effects. After *Correspondence: Jun Honda [j.honda1984@gmail.com](j.honda1984@gmail.com) 1Department of Anesthesiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan removal of the uterus and adnexa, 20 mg/5 ml of indigo carmine was administered via the right forearm catheter to check for ureteral injury, followed by 10 ml of normal saline. Blood pressure measured 1 min after indigo carmine administration was 84/63 mmHg. The patient’s urine was stained blue, with no dye leakage into the surgical field observed, and the procedure was concluded. After removing the dressing, pigment deposition was observed along the course of blood vessels distally from the cuff attachment site on the right forearm, extending even further distally than the intravenous insertion site (Fig. 1). Leakage of dye was observed not only in the vein where the intravenous line was placed, but also along the vein into the downstream veins and tributaries. There was no petechiae and evidence of extravasation at the right forearm venous access site. The patient recovered from anesthesia uneventfully, and the pigment deposition resolved within approximately 1 day. To date, only one report has described indigo carmine leakage distal to a proximally applied cuff, despite correct IV catheter placement within the vessel [1]. The Bier block, also known as intravenous regional anesthesia, is a technique where a tourniquet is applied proximal to avenous line placed in a limb [2], thereby confining the injected local anesthetic within the vasculature to achieve anesthesia of the limb. In the present case, extravasation occurred despite both the tourniquet time and drug dose being lower than those typically used in a Bier block procedure. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Co

FAQs

Why is indigo carmine administered during surgery?

Indigo carmine is commonly used intravenously to confirm the presence or absence of ureteral obstruction or injury by observing dye in urine.

What caused the extravasation in this case?

Extravasation occurred distal to the tourniquet (cuff) site after indigo carmine was administered into a forearm vein during temporary blood flow occlusion from a proximal blood pressure cuff.

How did the pigment deposition and patient outcome progress?

Pigment deposition appeared along distal vessel courses beyond the cuff and beyond the venous insertion site, and it resolved within approximately one day after surgery. The patient recovered from anesthesia without adverse events.

Sep 29, 2026

Uploaded by Jacob