Catheterization of the Posterior Tibial Artery in the Neonate

Abstract

\s=b\ Catheterization of the posterior tibial artery provides an alternative to cannulation of other arteries. We successfully catheterized this artery 17 times in 15 neonates whose weights ranged from 800 to 3,000 g. The catheters were placed percutaneously 13 times and by cutdown four times, and they remained in place for as long as 12 days (mean, 96 hours). Compromise of distal circulation was found in only two babies, both of whom had had umbilical artery catheters removed because of cyanosis of the toes that had resolved itself prior to posterior tibial artery cannulation. Our patients experienced no short-term complications from this procedure.(Am J Dis Child 133: [945][946] 1979) Intra-arteri al catheters are fre¬ quently used to monitor blood pressure and to provide access to arterial blood for determinations of blood gas levels in sick neonates.Commonly used sites for placing such catheters include the umbilical, the temporal, and the radial arteries. The cannulation of each of these arteries has been associated with serious thrombotic complications. In the neo¬ nate, the posterior tibial artery is easi¬ ly accessible for catheterization; theo¬ retically, thrombosis of this artery with loss of function distal to the clot would have a less serious impact than would thrombosis associated with oth¬ er sites of arterial cannulation. We have had a six-month experience with posterior tibial artery catheters in 15 infants. MATERIALS AND METHODSDuring the six-month period of from December 1977 to June 1978, catheteriza¬ tion of the posterior tibial artery was attempted 19 times and was successfully performed 17 times in 15 infants. The catheters were placed percutaneously in 13 instances and under direct vision by cutdown on four occasions. Unsuccessful percutaneous attempts were made in two babies who weighed less than 900 g.Percutaneous catheterization was per¬ formed using a method similar to that described by Cole et al1 for radial artery cannulation. The posterior tibial artery is illuminated with a fiber-optic light source placed posterior to the lateral malleolus. Usually, the posterior tibial artery pulsa¬ tion is easily seen posterior and inferior to the medial malleolus.2 After breaking the skin surface over the course of the artery with a plain 22-gauge needle, a 22-gauge catheter is inserted through the skin at a 45°a ngle. The artery is transfixed and the stylet is withdrawn to within 1 cm of the hub of the catheter. The catheter is then placed flush with the skin and slowly with¬ drawn until pulsatile blood flow is encoun¬ tered. At this point, the catheter is gently advanced into the lumen of the artery and secured in place with tape. The foot is then taped to a footboard, leaving the toes exposed to allow evaluation of the distal circulation.A cutdown technique is used when the posterior tibial artery cannot be seen easily using the fiberoptic light source. After taping the foot to a footboard, a transverse incision approximately 1 cm long is made posterior and inferior to the medial malleo¬ ...

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“…The tibial posterior artery has been used in paediatric patients, without major complications [ 65 , 66 ]. However, there also exists a case report of limb amputation secondary to a tibial artery catheterization [ 67 ].…”

Topical Nitroglycerine for Neonatal Arterial Associated Peripheral Ischemia following Cannulation: A Case Report and Comprehensive Literature Review

“…The respective vessels are also easily identified with a fibreoptic source, or the vessels are directly visible for catheterization (umbilical arteries). However, these purported safe sites are not without risk from ischemic changes and digital or limb necrosis [23–26]. Equally, the placement and position of umbilical arterial catheters may result in clinical vascular compromise.…”

Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review

“…The posterior tibial and dorsal pedis arteries may be possible alternative access sites to the radial artery in pediatric patients without major complications [ 7 , 12 – 14 ]. A study comparing the anatomical characteristics and utility of ultrasound-guided catheterization using the long-axis in-plane (LAX-IP) approach among the radial, posterior tibial, and dorsal pedis arteries in small children found that the posterior tibial artery is a reasonable alternative access site for ultrasound-guided radial arterial catheterization [ 15 ] because the first-attempt success rate, catheterization time, and arterial diameter of the posterior tibial artery are similar to those of the radial artery.…”