Catheter-induced brachial artery thrombosis in the neonate

Viezel-Mathieu, Alex; Lee, James; Zadeh, Teanoosh

doi:10.1097/01.xps.0000450328.16262.52

Cited by 1 publication

(4 citation statements)

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“…Medical management was successful in 36 patients out of 39 (92%), 5 6 8 11 12 14 15 16 17 18 19 20 21 26 30 whereas a combined approach of surgical and medical management was successful in 75% of patients (three out of four). 9 13 28 All patients who received GTN only achieved good outcomes. Of the four patients with poor outcomes, one case was due to a combined approach of heparin, iloprost, and surgical intervention, 25 one case due to tolasoline, 22 and two cases due to nerve block with bupivacaine.…”

Section: Resultsmentioning

confidence: 97%

“…Reviewing the 26 publications for site of peripheral arterial line insertion, there were, 17 arterial cannulas inserted in the femoral (30%), 9 10 11 12 13 14 14 radial (25%), 6 8 15 16 17 18 19 20 21 nine posterior tibial (16%), 8 17 19 22 eight brachial (14%), 9 10 23 24 25 26 27 28 one ulnar (2%), 29 and three of the sites were unknown but referred to as peripheral arterial cannulas (5%). 5 16 30 Four patients had repeated radial and brachial artery catheters inserted (7%).…”

Section: Resultsmentioning

confidence: 99%

“…With regard to treatment interventions, the majority (39 patients) were treated medically (71%), 5 6 8 11 12 14 15 16 17 18 19 20 21 22 26 29 30 10 patients were treated surgically (18%), 9 10 23 24 27 31 five patients were treated both medically and surgically (9%), 9 13 25 28 and one patient was treated conservatively with debridement and accurate approximation (2%). 10 Thrombectomy and arteriotomy with microvascular reconstruction was the most common intervention in the 10 surgically managed patients, four patients received heparin followed by the surgical interventions, 9 13 28 and one patient received heparin, iloprost, and surgical intervention. 25 There was a wide variety of medical interventions that were given to the 39 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the interventions were successful in treating limb ischemia with 50 patients (91%) achieving a good outcome. 5 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 23 24 26 27 28 30 31 Only four patients (7%) were faced with poor outcomes, 16 22 25 29 and there was one case of an unknown outcome as the patient died of issues unrelated to limb ischemia. 9 All surgical interventions achieved good outcomes as well as conservative management.…”

Section: Resultsmentioning

confidence: 99%

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Management of Neonatal Limb Ischemia Secondary to Peripheral Arterial Lines: A Systematic Review

Slee

2022

J Pediatr Intensive Care

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Limb ischemia is a rare complication of peripheral arterial lines, but there is inconsistency with management. We aimed to describe the variation in the management of limb ischemia secondary to a peripheral arterial line and to determine a consensus for management. The systematic review consisted of searching PubMed, Scopus, Ovid MEDLINE, Google Scholar, Cochrane Database of Systematic Reviews, and references of journals using pre-trialed medical subject headings terms and articles. The sources were scrutinized against inclusion and exclusion criteria. Twenty-six articles were included for full-text analysis: seven retrospective reviews and 19 case reports. The most common site of insertion was femoral (30%), followed by radial (25%). Seventy-one percent of the patients were treated medically, 18% surgically, 9% both medically and surgically, and one patient was treated conservatively with debridement and accurate approximation. The majority of interventions were successful in treating limb ischemia, with 91% achieving a good outcome. All patients who received glyceryl trinitrate (GTN) and all surgical interventions, including conservative management, achieved good outcomes. Medical management was successful in 92%, whereas a combined approach of surgical and medical management was successful in 75% of patients. There is wide variation in the management of limb ischemia secondary to peripheral arterial lines. There is apparent success observed with topical 2% GTN and surgical interventions, with thrombolysis and, in case of no improvement, with thrombectomy, across various studies. We recommend that an updated international consensus be reached on the management of neonates with limb ischemia secondary to a peripheral arterial line.

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