Femoral artery catheterization in neonates and infants

Objective: To determine the incidence of perfusion-related complications associated with indwelling femoral artery monitoring catheters in neonates and infants following introduction of a 2.5-F diameter, 5-cm length, polyethylene catheter (Cook Medical, Bloomington, IN) to our unit. Design: Prospective observational cohort study. Setting: Pediatric cardiac intensive care unit in a university-affiliated children's hospital. Patients: All patients <2 yrs old with an indwelling femoral artery catheter during a 3-yr period. Interventions: None. Measurements and Main Results: Two hundred eighty-two patients (including 98 neonates), median (range) age 10 wks (0.1-84), weight 4.1 kg (2.0-11.1) were enrolled; outcomes in 249 were evaluable. Pulse strength in dorsalis pedis arteries and pulse discrepancies between feet were assessed hourly by the cardiac intensive care unit nurse and recorded on a flow sheet. Nonpalpable pulses were assessed as absent or present with ultrasonic Doppler. Following removal of the catheter, assessments of pulse strength continued until resolution of any discrepancies. Median (range) duration of catheterization was 4 days (1-23). Catheters of 2.5-F diameter were used in 227 patients and larger catheters in 55 patients. The incidence of pulse strength discrepancies between feet was 20%, loss of pulse was 3.4% (6.7% in neonates, 1.4% in older infants) when extracorporeal membrane oxygenation patients were excluded, and resolution of pulse discrepancy or loss was 100%. Duration of catheterization and use of a catheter larger than 2.5 Fr were significant predictors of loss of pulse. Conclusions: Loss of pedal pulse distal to small-bore monitoring femoral artery catheters in neonates and infants is directly related to the duration of catheterization and is less frequent when 2.5-F, 5-cm polyethylene catheters are used instead of larger catheters. (Pediatr Crit Care Med 2012; 13:39-41)