Pediatric Arterial Catheters

Indwelling arterial catheters are widely used for hemodynamic monitoring and blood sampling purposes in neonatal and pediatric patients. Arterial catheters are inserted through the umbilical artery in premature and term infants, while the radial artery route is utilized in larger children. Other alternative sites for insertion include the ulnar, brachial, axillary, dorsalis pedis and tibialis posterior arteries. Most arterial catheters in children benefit from placing them using ultrasound guidance. Almost one-third of all children with an indwelling arterial catheter will have a complication. The most common complications while using arterial catheters include catheter-related infection or inflammation, mechanical complications, embolic or thrombotic complications and bleeding. Arterial thrombosis may cause serious short-term and/or long-term complications in children, including skin necrosis, threatened limb or organ viability, leg length differences, claudication, and loss of arterial access. Another important complication of arterial catheters is bleeding when antithrombotic therapy is utilized. Possible explanations for the thrombogenicity of intraarterial catheters include damage to the vessel wall, the foreign surface, and disruption of the blood flow. This complication increases when the femoral route is utilized when compared with the radial artery. In cases where the umbilical artery is catheterized, renal flow and changes should be closely monitored. Insertion attempts of the arterial catheter at multiple sites during the admission and the presence of more than one provider participating in line placement are significant risk factors for subsequent complications. Mechanical complications or line malfunction includes leaking, removed by patient, nonfunctional, no blood return, blanching, occluded or swelling at the line site. Pronovost's prospective checklist for arterial line safety has had success in reducing the frequency of at least the most serious complications in children.

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