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Brachial Artery Catheterization in Swine
Published on: March 30, 2019
Complications associated with arterial catheterization in children
Mary A King1, Michelle M Garrison, Monica S Vavilala
1Children's Hospital and Regional Medical Center, Critical Care, Seattle, WA, USA. marypicu@gmail.com
Insights
Arterial catheterization complications occurred in 10.3% of pediatric patients, with infection being most common. Risk factors included younger age, later catheter insertion, and specific medical conditions, highlighting the need for careful monitoring in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Vascular access management
- Patient safety in healthcare
Background:
- Arterial catheters are crucial for hemodynamic monitoring in critically ill children.
- Complications associated with arterial catheterization can lead to significant morbidity.
- Understanding the prevalence and risk factors for these complications is essential for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of arterial catheterization complications in a large pediatric cohort.
- To identify independent risk factors associated with these complications.
- To generate hypotheses for future prospective research on arterial catheter placement.
Main Methods:
- Retrospective cohort study of 10,394 pediatric patients from 33 children's hospitals.
- Inclusion criteria: age 1 month to 18 years, pediatric intensive care unit admission, arterial catheter use, and hospitalization >or=1 day post-placement.
- Complications identified via ICD-9 codes, including thrombosis, embolism, and infection.
Main Results:
- Overall complication rate was 10.3%, with infection/inflammation being the most frequent (61.8%).
- Independent predictors of complications included younger age (5-11 months, 1-2 years), later catheter insertion, cardiac surgery, bone marrow transplant, and dialysis.
- No association found with gender, Medicaid status, coagulopathy, or shock.
Conclusions:
- Arterial catheterization complications are prevalent in critically ill children.
- Limitations in ICD-9 coding prevented accounting for central venous catheterization effects.
- Further prospective studies are needed to validate findings and guide best practices for arterial catheter use.
Objectives:
To examine the prevalence of and risk factors associated with arterial catheterization complications in a large pediatric patient population in an effort to generate hypotheses for future prospective study of arterial catheter placement.
Design:
Retrospective cohort study.
Setting:
Patients discharged between January 1, 2000, and March 31, 2005, from 33 children's hospitals belonging to the Child Health Corporation of America.
Patients:
Patients were 10,394 children identified from the Pediatric Health Information System database. Inclusion criteria included age 1 month to 18 yrs, admitted to a pediatric intensive care unit, received an arterial catheter for monitoring, and hospitalized for >or=1 day following catheter placement.
Interventions:
None.
Measurements And Main Results:
We assessed complications as defined by ICD-9 coding associated with arterial catheterization, including thrombosis, embolism, and infection. Complications were reported in 10.3% (1,072) of patients, most frequently infection/inflammation (61.8%), complication of vascular device not otherwise specified (14.9%), mechanical complications (14.1%), and embolic or thrombotic issues (7.5%). Independent predictors of complications associated with arterial catheterization were age (compared with 1-4 months) of 5-11 months (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.25-1.82) or 1-2 yrs (OR 1.39; 95% CI 1.09-1.78), insertion of catheters after the first hospital day and need for cardiac surgery (OR 1.31; 95% CI 1.03-1.68), bone marrow transplantation (OR 1.79; 95% CI 1.19-2.70), and dialysis (OR 1.36; 95% CI 1.05-1.77). There was no association of arterial catheter complications with patient gender, Medicaid status, or presence of coagulopathy or shock.
Conclusions:
Complications associated with arterial catheterization are common in critically ill children. Significantly, we were unable to account for the potential confounding effect of central venous catheterization in this study secondary to limitations of ICD-9 coding. This study serves as a hypothesis-generating report of a large pediatric sample and suggests the need to carefully assess arterial catheter-associated complications in a prospective study independent of central venous catheters.
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