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Pediatric arterial catheters: Complications and associated risk factors
Ferdynand Hebal1, Hayley T Sparks1, Karen L Rychlik2
1Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.
Insights
Pediatric arterial catheter complications occurred in 33% of patients. More providers during insertion and multiple insertion attempts were linked to increased risks of arterial catheter complications.
Area of Science:
- Pediatric critical care medicine
- Vascular access devices
- Patient safety
Background:
- Arterial catheter complications are frequent in pediatric critical care.
- Existing data on complication rates and risk factors are inconsistent.
Purpose of the Study:
- To identify risk factors for peripheral arterial catheter complications in pediatric patients.
- To analyze complication rates in a pediatric intensive care unit setting.
Main Methods:
- Retrospective cohort study of pediatric inpatients (≤18 years) undergoing arterial line placement.
- Review of electronic medical records and provider notes for complications and insertion-related factors.
- Data collected between January 1, 2008, and January 1, 2013.
Main Results:
- Of 228 children, 75 (33%) experienced 106 complications.
- Common complications: line malfunctions (59%), bleeding (16%), multiple complications (11%), infiltration (8%), hematoma (4%).
- Independent predictors of complications included multiple providers during insertion (p=0.007) and multiple insertion sites (p=0.036).
Conclusions:
- The study highlights provider-related factors influencing arterial catheter complications in children.
- Further prospective research is recommended to validate these findings and assess provider-related risks.
Background/Purpose:
Arterial catheter complications are a common problem in a pediatric critical care setting, but reported complication rates and risk factors associated with peripheral arterial catheter complications vary. We conducted a retrospective cohort study to identify risk factors in a pediatric patient population.
Methods:
We performed a detailed abstraction of provider notes in the electronic medical records of inpatients ≤18years of age who underwent arterial line placement between January 1, 2008 and January 1, 2013 at a university-affiliated standalone pediatric hospital. Inpatient records were assessed for complications associated with arterial catheterization and risk factors inherent to arterial catheter insertion.
Results:
Two hundred twenty-eight children were identified, of whom 75 (33%) had a total of 106 arterial catheter complications. Complications included line malfunctions (59%, n=63), bleeding (16%, n=17), multiple complications (11%, n=12), infiltration (8%, n=9), and hematoma (4%, n=4). Line malfunction was reported in all patients with multiple complications. Independent predictors of complications associated with arterial catheterization were the presence of more than one provider during the insertion (p=0.007) and insertion attempts at multiple sites (p=0.036).
Conclusions:
Our analysis suggests the need for a prospective study to comprehensively assess provider-related risk factors associated with arterial catheter complications in children.
Level Of Evidence:
IV.
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