Pediatric arterial catheters: Complications and associated risk factors

Hebal, Ferdynand; Sparks, Hayley T.; Rychlik, Karen; Bone, Meredith; Tran, Sifrance; Barsness, Katherine A.

doi:10.1016/j.jpedsurg.2017.08.057

Cited by 20 publications

(22 citation statements)

References 19 publications

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“…However, arterial sampling can be challenging in children, and complications are not uncommon. 3,4 Capnography allows for noninvasive, continuous measurement of end-tidal carbon dioxide (EtCO 2 ) with lower cost and fewer complications compared with arterial cannulation, and it is widely used in clinical pediatric practice as a substitute for arterial cannulation. 5 End-tidal CO 2 reasonably estimates Pa co 2 in healthy adults.…”

Section: Introductionmentioning

confidence: 99%

Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury

et al. 2019

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Key Points Question Is end-tidal carbon dioxide (EtCO 2 ) a reliable surrogate for partial pressure of carbon dioxide, arterial (Pa co 2 ) in children admitted to the intensive care unit with traumatic brain injury? Findings In this secondary analysis of a prospective cohort study that included 445 paired Pa co 2 -EtCO 2 values from 137 patients, only 42.0% of Pa co 2 values were within 0 to 5 mm Hg of paired EtCO 2 values. Development of pediatric acute respiratory distress syndrome within 24 hours after admission was associated with significantly lower likelihood of Pa co 2 -EtCO 2 agreement than was no development of pediatric acute respiratory distress syndrome. Meaning This study suggests that EtCO 2 values are not a reliable substitute for Pa co 2 values during the first 24 hours after pediatric traumatic brain injury, especially in the presence of pediatric acute respiratory distress syndrome.

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Section: Introductionmentioning

confidence: 99%

Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury

et al. 2019

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“…13 Our findings are in support of previous evidence suggesting 10e33% of children requiring arterial catheterisation will experience a device-related complication. 7,9 A retrospective analysis of 10,000 PACs reported catheter-related infections and inflammation (61%) as the most prevalent PAC complications in paediatrics. 9 However, we did not observe a similar rate of infectious complications, but a longer observation period would have been required to capture events.…”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective study of 229 PACs lends support to our findings. Habel et al 7 found a bloodstream infection rate of 0% but reported 59% of PACs in paediatric critical care experienced an episode of line malfunction (defined as nonfunctional, e.g., no waveform or blood return or blanching). Traditionally, paediatric vascular access studies have focused on high cost complications such as bloodstream infection.…”

Section: Discussionmentioning

confidence: 99%

Insertion, management, and complications associated with arterial catheters in paediatric intensive care: A clinical audit

Schults

Long

Pearson

et al. 2020

Australian Critical Care

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Introduction: Peripheral arterial catheters (PAC) are used for haemodynamic monitoring and blood sampling in paediatric critical care. Limited data are available regarding PAC insertion and management practices, and how they relate to device function and failure. This information is necessary to inform future interventional research. Objectives: The primary objective of this study was to describe PAC insertion and management practices, and associated complications. Secondary objectives were to determine patient and clinical characteristics associated with risk of PAC successful insertion and failure. Methods: A prospective, observational study was conducted in the anaesthetic department and paediatric intensive care unit of a tertiary paediatric facility. Data were collected on PAC insertion, PAC management and PAC removal. Standard incidence and prevalence were calculated per 1,000 device days. Risk factors for multiple insertions and PAC failure were identified using Cox regression. Results: A total of 100 catheters in 89 children were examined capturing 472 device days. PACs were primarily inserted for blood sampling (78%) in the radial artery (78%) using ultrasound guidance (67%), with 31% inserted on first attempt. Heparin saline solution was used in 82% of devices. Median catheter dwell was 50.6 hours (IQR 24.0 e 158.0), with PAC failure occurring in 19 devices (20%), at a rate of 40.2 per 1000 catheter days (95% CI 25.7 -63.1). Arm board immobilisation (HR 2.9; 95% CI 1.02-8.02; p ¼ 0.05), higher PIM3 score (HR 1.06; 95% CI 1.03-1.09; p < 0.01) was associated with an increased the risk of PAC failure, and non-2% chlorhexidine antisepsis was associated with a decrease in PAC failure (HR 0.32; 95% CI 0.11-0.96; p ¼ 0.04), in univariate analysis. Conclusions: PAC insertion is challenging, and failure is common. Prospective clinical trial data is needed to identify high risk patient groups and to develop interventions which optimise practices, thereby reducing failure.

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“…Given the high correlation of illness severity with the use of invasive medical technology among the critically ill pediatric population, 21 this finding is likely related to illness severity and the associated need to monitor and sustain end-organ function. Aside, the use of these invasive technologies is not free of complications, [22][23][24][25][26][27] which could also lengthen hospital stay. Abbreviation: APRDRG, all patient refined diagnosis-related groups.…”

Section: Discussionmentioning

confidence: 99%

Resource Use and Outcomes for Children Hospitalized With Severe Sepsis or Septic Shock

Odetola

2019

J Intensive Care Med

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Objective: To describe patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and charges for children with severe sepsis or septic shock who often require specialized organ-supportive technology to enhance outcomes, availability of which might vary across hospitals. Design: Retrospective study among children hospitalized for severe sepsis or septic shock, using the 2012 Kids’ Inpatient Database. Multivariate regression methods identified factors associated with mortality, LOS, and charges. Measurements and Main Results: Of an estimated 11 972 hospitalizations for pediatric severe sepsis or septic shock, most hospitalizations (85%) were to urban teaching hospitals. Hospitalizations were more frequent among neonates and older adolescents than other age groups. Mortality was 17%, average LOS was 24 days, and average hospital charges were US$314 950. Higher mortality was associated with neonates, cumulative organ dysfunction, more comorbidities, and cardiopulmonary resuscitation. Longer hospitalization and higher charges were associated with neonates, more comorbidities, higher illness severity, invasive medical technology, and urban hospitals. Conclusions: Efforts to mitigate the substantial in-hospital mortality and resource use observed in pediatric severe sepsis or septic shock should be age-specific and focused on the influence of comorbidities and organ dysfunction on outcomes. Future research should elucidate reasons for higher resource use at urban hospitals.

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Pediatric arterial catheters: Complications and associated risk factors

Cited by 20 publications

References 19 publications

Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury

Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury

Insertion, management, and complications associated with arterial catheters in paediatric intensive care: A clinical audit

Resource Use and Outcomes for Children Hospitalized With Severe Sepsis or Septic Shock

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