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Practice Variation in Arterial Catheter Placement: A Survey of Pediatric Critical Care Practitioners
Mary S Pilarz1,2, Christopher D Mattson1,2, Cara M Pritchett1,2
1Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Pediatric critical care clinicians show wide variation in arterial catheter placement practices, including technique and indications, despite existing guidelines. Further research is needed to standardize ultrasound use and improve patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Device Placement
- Clinical Practice Variation
Background:
- Lack of consensus on arterial catheter (AC) indications in critical care.
- No definitive evidence linking AC use to improved patient outcomes.
- Significant variability in AC utilization across pediatric intensive care units (PICUs), unrelated to patient severity.
Purpose of the Study:
- To investigate arterial catheter placement practices among pediatric critical care clinicians.
- To identify variations in techniques, indications, and attitudes regarding AC use.
- To characterize current real-world practices in pediatric ICUs.
Main Methods:
- Anonymous, cross-sectional web-based survey.
- Data collected from 377 pediatric critical care practitioners across 93 institutions.
- Inquired about techniques, site selection, and indications for arterial catheter placement.
Main Results:
- Ultrasound use during placement was reported by 52.0% of respondents, with fellows using it more than attendings.
- The Seldinger technique (catheter-over-wire) was the predominant insertion method (88.1%).
- Radial artery (97.3%) and femoral artery (81.1%) were preferred for peripheral and central cannulation, respectively. Significant variability existed in indications, with 68.9% citing single vasoactive support.
Conclusions:
- Wide practice variation in arterial catheter placement persists among pediatric ICU clinicians, even with existing guidelines.
- Gaps in evidence regarding ultrasound-guided techniques and securement methods require further investigation.
- Optimizing practices through research is crucial for improving patient outcomes in pediatric critical care.
Abstract:
BackgroundThere is not a consensus in critical care medicine on when arterial catheters are indicated, nor is there evidence that ACs improve patient outcomes. There is wide variability in AC use across PICUs that is independent of illness severity.ObjectiveTo characterize arterial catheter placement practices among pediatric critical care clinicians and identify practice variability in techniques, indications, and attitudes.DesignAnonymous, cross-sectional web-based survey.Measurements and Main ResultsData were collected from 377 pediatric critical care practitioners across 93 institutions. The majority were attending physicians (n = 215, 57.0%) or fellows (n = 141, 37.4%). Ultrasound was always used for arterial catheter placement by 52.0% (196/377) of respondents, with fellows being more likely than attendings to use ultrasound (P = .005). The catheter-over-wire (Seldinger) technique was the most common insertion method (332/377, 88.1%). For site selection, the radial artery was preferred for peripheral placement (97.3%), and the femoral artery for central cannulation (81.1%). There was substantial variability in the reported indications for arterial catheter use, with 68.9% considering single vasoactive support as an indication.ConclusionsThis study demonstrates wide practice variation in arterial catheter placement among pediatric ICU clinicians, despite the existence of some practice guidelines. Future research should focus on addressing gaps in evidence, particularly around ultrasound-guided techniques and securement methods, to optimize practices and improve outcomes.
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