Clinical experience of use of percutaneous peripheral arterial cannulation in sick neonates in a developing country

Background Continuous invasive arterial monitoring is necessary in sick neonates needing hemodynamic and ventilatory support. The primary objective of our study was to describe clinical experience with percutaneous peripheral arterial cannulation (PAC) in sick neonates. Methods Neonates needing PAC were prospectively enrolled in the study. Inclusion criteria were: neonates needing respiratory support (invasive or non-invasive), neonates requiring vasoactive medications or neonate likely to need more than 5 sampling pricks in 24 h. Results One hundred eight neonates (93.1%) needed cannulation of one arterial site while 8 (6.9%) needed cannulation of 2 arterial sites, thus giving a total of 124 cannulations. Out of the 124 cannulations, 102 (82%) were performed in first attempt, while 22 (18%) cannulations needed 2 or more attempts. Serious complications like discolouration of digits, blanching of skin or bleeding were seen in 6 (4.9%) cannulations. These resolved after removal of arterial line and no long term consequences were noted. On comparing neonates having radial arterial cannulation(n = 108) with posterior tibial arterial cannulation (n = 16) there was no difference in duration of arterial line between radial artery group (mean, SD 53.30 +/- 22.56) and posterior tibial artery group (mean, SD 48.25 +/- 27.39). However, more attempts were needed to cannulate post tibial artery (mean, SD 2.25 +/- 1.32) as compared to radial artery (mean 1.22 +/- 0.789) and this difference was statistically significant (MD -1.02, 95% CI - 1.75 to - 0.30). There was no difference in incidence of serious complications between the radial artery group (3.7%, n = 4) as compared to posterior tibial group (5.5%, n = 1, OR 0.57, 95% CI 0.06-5.51, p = 0.63). Conclusions Peripheral arterial cannulation is a safe method for hemodynamic monitoring and blood sampling in sick neonates. Complications can be minimized by diligent monitoring and proactive removal of line if there is damping of tracing.

Automated summary

Peripheral arterial cannulation is a safe and effective method for hemodynamic monitoring and blood sampling in sick neonates, though careful attention to cannulation technique is necessary. Posterior tibial artery cannulation requires more attempts compared to radial artery cannulation, but there is no significant difference in duration of arterial line or incidence of serious complications.