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Insertion, management, and complications associated with arterial catheters in paediatric intensive care: A clinical
Jessica A Schults1, Debbie Long2, Kylie Pearson2
1Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia.
Insights
Peripheral arterial catheters (PACs) are challenging to insert and fail frequently in pediatric critical care. Optimizing insertion and management practices is crucial to reduce PAC failure rates.
Area of Science:
- Pediatric Critical Care Medicine
- Vascular Access Devices
- Hemodynamic Monitoring
Background:
- Peripheral arterial catheters (PACs) are vital for hemodynamic monitoring and blood sampling in pediatric intensive care units (PICUs).
- Current data on PAC insertion and management practices, and their impact on device function and failure, are limited.
- Understanding these practices is essential for improving patient outcomes and guiding future research.
Purpose of the Study:
- To describe current practices for PAC insertion and management in a tertiary pediatric facility.
- To identify complications associated with PAC use.
- To determine patient and clinical factors linked to successful PAC insertion and device failure.
Main Methods:
- A prospective, observational study was conducted in an anesthetic department and PICU.
- Data were collected on 100 PACs in 89 children over 472 device days.
- Cox regression analysis was used to identify risk factors for PAC insertion failure and overall device failure.
Main Results:
- PACs were mainly used for blood sampling (78%) via radial artery (78%) with ultrasound guidance (67%).
- Device failure occurred in 20% of PACs (40.2 per 1000 catheter days).
- Arm board immobilization and higher PIM3 scores increased PAC failure risk, while 2% chlorhexidine antisepsis decreased it.
Conclusions:
- PAC insertion is technically challenging, and device failure is a common occurrence in pediatric critical care.
- Further clinical trials are needed to identify high-risk patient populations.
- Optimizing PAC insertion and management protocols is necessary to minimize failure rates.
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 - 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 = 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 = 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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