Major Short-term Complications of Arterial Cannulation for Monitoring in Children

Abstract

Background Perioperative arterial cannulation in children is routinely performed. Based on clinical observation of several complications related to femoral arterial lines, the authors performed a larger study to further examine complications. The authors aimed to (1) describe the use patterns and incidence of major short-term complications associated with arterial cannulation for perioperative monitoring in children, and (2) describe the rates of major complications by anatomical site and age category of the patient. Methods The authors examined a retrospective cohort of pediatric patients (age less than 18 yr) undergoing surgical procedures at a single academic medical center from January 1, 2006 to August 15, 2016. Institutional databases containing anesthetic care, arterial cannulation, and postoperative complications information were queried to identify vascular, neurologic, and infectious short term complications within 30 days of arterial cannulation. Results There were 5,142 arterial cannulations performed in 4,178 patients. The most common sites for arterial cannulation were the radial (N = 3,395 [66.0%]) and femoral arteries (N = 1,528 [29.7%]). There were 11 major complications: 8 vascular and 3 infections (overall incidence, 0.2%; rate, 2 per 1,000 lines; 95% CI, 1 to 4) and all of these complications were associated with femoral arterial lines in children younger than 5 yr old (0.7%; rate, 7 per 1,000 lines; 95% CI, 4 to 13). The majority of femoral lines were placed for cardiac procedures (91%). Infants and neonates had the greatest complication rates (16 and 11 per 1,000 lines, respectively; 95% CI, 7 to 34 and 3 to 39, respectively). Conclusions The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Ultrasound-guided arterial catheterization

“…The radial artery is the most commonly preferred site for arterial catheterization [ 4 , 5 ] because of adequate collateral blood supply, low complication rates, and easy accessibility. The average diameter of the radial artery in adults and children is 2.2–2.3 ± 0.4 mm [ 6 , 7 ] and 1.2–1.3 ± 0.2 mm [ 8 , 9 ], respectively.…”

“…However, complications associated with arterial catheterization are common in critically ill adults [ 61 ] and children [ 62 ]. Younger children, such as neonates and infants, have a higher risk of complications [ 5 ]. The overall complication rate was 32.1% in patients aged < 2 years.…”

“…Furthermore, complications vary depending on the catheterization site. Recently, the overall major complication rate within 30 days was 0.034–0.2% in adults [ 4 ] and children [ 5 ], but the complication rate related to the femoral artery was 0.7–25% in children [ 5 , 22 ]. Site-specific complications are related to the anatomical characteristics of these arteries.…”

“…The incidence rates of arterial catheter-associated infections and sepsis are reported to be 0.024–0.38% in adults [ 4 , 64 ] and 1.4% in children [ 5 ]. One meta-analysis revealed that the incidence of arterial catheter-related bloodstream infections was 0.7% [ 70 ].…”

Advances in Non-Invasive Blood Pressure Monitoring

“…While insertion of an IAL is considered essential for many critically ill patients and is generally benign for adults [ 12 , 37 , 38 ], it is more problematical for children who have smaller arteries and a greater tendency for vasospasm and must generally be sedated [ 11 , 12 , 15 , 41 , 43 , 44 , 45 , 46 , 47 , 48 ]. Neonates are particularly at risk due to their fragile skin [ 49 ].…”