Evaluation of Arterial Catheter Management in Very Preterm Neonates: Peripheral Artery Versus Umbilical Artery

Abstract

:Objectives : To evaluate whether peripheral arterial catheter management is more effective than umbilical arterial management in very preterm neonates.Methods : Thirty -eight very preterm neonates born in Fukushima Medical University Hospital between October 2008 and March 2010 were evaluated. A peripheral arterial catheter was inserted in 19 neonates (peripheral group) and an umbilical arterial catheter in the remaining 19 neonates (umbilical group).Results : The median gestational ages of the peripheral and umbilical groups were 195 and 185 days, respectively (p=0.04). The systolic and diastolic blood pressure (BP) was significantly higher in the peripheral group than in the umbilical group (p=0.03 and p=0.001). There was a significant relationship between BP at cannulation and urinary output after cannulation for 24 h in the peripheral group (r s =0.49, p=0.03) ; however, no such significant relationship was found in the umbilical group.Conclusions : We considered that peripheral artery catheters provide a well -functioning route for continuous BP monitoring, even in very preterm neonates. Because umbilical catheter placement might affect urinary output, we speculated that peripheral arterial catheter placement would be a more effective management strategy than umbilical arterial catheter placement in very preterm neonates. Further studies of larger populations are necessary to evaluate the effectiveness of arterial management including long -term follow -up studies.

Peripheral Arterial Lines in Extremely Preterm Neonates

“…In pediatric and adult intensive care medicine, peripheral arterial lines (PALs) are routinely used for the same purpose as UACs in preterm neonates. PALs in extremely preterm neonates are rarely used, especially in the first days of life, but might offer a promising alternative to UACs since they allow for blood pressure monitoring and blood sampling 7. The consequences of thromboembolic events and other vascular complications might be less severe than those with UACs because of their localization.…”

“…Comparable life spans of approximately 5 days have been described for PALs and UACs in preterm neonates 7. Unit policies on line management differ, but a steady increase in complications such as nosocomial infections or necrotizing enterocolitis has been observed with longer duration of UAC use 1…”

“…PALs in extremely preterm neonates are rarely used, especially in the first days of life, but might offer a promising alternative to UACs since they allow for blood pressure monitoring and blood sampling. 7 The consequences of thromboembolic events and Mense et al other vascular complications might be less severe than those with UACs because of their localization. The incidence of PAL complications in preterm neonates is not well published.…”

“…11,12 Comparable life spans of approximately 5 days have been described for PALs and UACs in preterm neonates. 7 Unit policies on line management differ, but a steady increase in complications such as nosocomial infections or necrotizing enterocolitis has been observed with longer duration of UAC use. 1 PALs became standard of care for extremely preterm neonates instead of UACs in our level III neonatal center in 2015 after severe thromboembolic events associated with UACs had been observed in 2 of the most premature patients.…”

Cateteres umbilicais em recém-nascidos: indicações, complicações e diagnóstico por imagem

“…A suspeita de espasmo vascular ocorre na presença de sinais isquêmicos distais progressivos, como palidez de um membro, ausência de pulso e gangrena em casos avançados [1,6,7,23]. Cateteres umbilicais arteriais em posição baixa (T12-L3) podem estar associados à redução de fluxo nas artérias renais de recém-nascidos pré-termo, podendo reduzir o débito urinário [6,24]. O tromboembolismo da artéria renal é geralmente iatrogênico, relacionado ao cateterismo da artéria umbilical, representando a principal causa de hipertensão renovascular em recém-nascidos [22].…”