Major Short-term Complications of Arterial Cannulation for Monitoring in Children
This is a retrospective chart review assessing complications of arterial cannulation for monitoring of paediatric patients undergoing surgical procedures at a single institution over 10 years to August 2016. There were 5142 arterial cannulations in 4178 patients, 66% were radial, 29.7% femoral and 4.3% other. The authors report 11 major complications (8 vascular and 3 catheter related blood stream infections); all of which were associated with femoral cannulation in children aged less than 5 years. There were no documented complications in distal cannulation sites, including radial arterial.
It is surprising that this large retrospective review identified no detectable problems with radial arterial cannulation. A small number of serious problems with femoral cannulation in small children was identified. While the usual caveats on retrospective data apply; at the time of this study, femoral cannulation was their preferred approach in cardiac anaesthesia. The results presented have already changed practice for the reporting institution, with radial cannulation now preferred and femoral cannulation reserved for second or third line. It is further noted that the seven serious vascular complications occurred not only all in small children, but also all were in association with the use of larger catheters (3F, 3.5F, 20G). Larger catheter use in smaller arteries would be expected to result in a higher rate of vascular complications, but it is not clear from the paper what proportion of femoral lines were larger (3F, 3.5F, 20G) and what proportion where smaller (22G). Use of smaller catheters, direct single-puncture, ultrasound-guided cannulation and improved sterile technique may be expected to reduce complications. The authors conclusions however remain relevant:
- The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%).
- All major complications were observed in femoral arterial lines in children less than 5 years of age – particularly neonates and infants.
- No detected complications occurred in distal arterial sites including more than 3000 radial artery cannulations.
Reviewed by Dr. Christopher Holmes