Complications Associated With Arterial Catheterization in Children.
Complications Associated With Arterial Catheterization in Children.
Objectives: To examine the prevalence of and risk factors associated with arterial catheterization complications in a large pediatric patient population in an effort to generate hypotheses for future prospective study of arterial catheter placement.
Design: Retrospective cohort study.
Setting: Patients discharged between January 1, 2000, and March 31, 2005, from 33 children's hospitals belonging to the Child Health Corporation of America.
Patients: Patients were 10,394 children identified from the Pediatric Health Information System database. Inclusion criteria included age 1 month to 18 yrs, admitted to a pediatric intensive care unit, received an arterial catheter for monitoring, and hospitalized for ≥1 day following catheter placement.
Interventions: None.
Measurements and Main Results: We assessed complications as defined by ICD-9 coding associated with arterial catheterization, including thrombosis, embolism, and infection. Complications were reported in 10.3% (1,072) of patients, most frequently infection/inflammation (61.8%), complication of vascular device not otherwise specified (14.9%), mechanical complications (14.1%), and embolic or thrombotic issues (7.5%). Independent predictors of complications associated with arterial catheterization were age (compared with 1-4 months) of 5-11 months (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.25-1.82) or 1-2 yrs (OR 1.39; 95% CI 1.09-1.78), insertion of catheters after the first hospital day and need for cardiac surgery (OR 1.31; 95% CI 1.03-1.68), bone marrow transplantation (OR 1.79; 95% CI 1.19-2.70), and dialysis (OR 1.36; 95% CI 1.05-1.77). There was no association of arterial catheter complications with patient gender, Medicaid status, or presence of coagulopathy or shock.
Conclusions: Complications associated with arterial catheterization are common in critically ill children. Significantly, we were unable to account for the potential confounding effect of central venous catheterization in this study secondary to limitations of ICD-9 coding. This study serves as a hypothesis-generating report of a large pediatric sample and suggests the need to carefully assess arterial catheter-associated complications in a prospective study independent of central venous catheters.
Arterial catheters are commonly used in the pediatric intensive care unit (PICU) to facilitate continuous blood pressure monitoring and frequent sampling of blood. However, arterial catheters are not without complications. Studies in adults have found that complications occur in as many as 10% of arterial catheterizations. For example, Frezza and Mezghebe, in a study of nearly 5,000 adults, found that 3.0% to 4.6% of adult intensive care unit (ICU) patients with arterial catheters had vascular insufficiency related to the catheter. An additional 2% to 3% had bleeding and 1% had infection. Overall, 10% to 13% of patients had complications associated with arterial catheter placement. Another study of 93 adult ICUs in Australia found that approximately one in five patients with arterial catheter complications suffered an injury, from either ischemia, bleeding, or infection. In this study, most of the human risk factors for complications were knowledge and rule-based errors. In adult postoperative cardiac surgery patients, infection occurred in about 0.2% of arterial catheters. Although multiple adult studies have demonstrated abnormal arterial flow or occlusion after removal of arterial catheters, the frequency of ischemic damage in those studies was extremely low.
There have been few studies of arterial catheter complications in children, and most of these have been in neonates or infants. No study has examined a large patient population or examined risk factors for complications in children with arterial catheters. This study was conducted to determine the frequency of and risk factors for complications associated with arterial cannulation in the pediatric age group.
Objectives: To examine the prevalence of and risk factors associated with arterial catheterization complications in a large pediatric patient population in an effort to generate hypotheses for future prospective study of arterial catheter placement.
Design: Retrospective cohort study.
Setting: Patients discharged between January 1, 2000, and March 31, 2005, from 33 children's hospitals belonging to the Child Health Corporation of America.
Patients: Patients were 10,394 children identified from the Pediatric Health Information System database. Inclusion criteria included age 1 month to 18 yrs, admitted to a pediatric intensive care unit, received an arterial catheter for monitoring, and hospitalized for ≥1 day following catheter placement.
Interventions: None.
Measurements and Main Results: We assessed complications as defined by ICD-9 coding associated with arterial catheterization, including thrombosis, embolism, and infection. Complications were reported in 10.3% (1,072) of patients, most frequently infection/inflammation (61.8%), complication of vascular device not otherwise specified (14.9%), mechanical complications (14.1%), and embolic or thrombotic issues (7.5%). Independent predictors of complications associated with arterial catheterization were age (compared with 1-4 months) of 5-11 months (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.25-1.82) or 1-2 yrs (OR 1.39; 95% CI 1.09-1.78), insertion of catheters after the first hospital day and need for cardiac surgery (OR 1.31; 95% CI 1.03-1.68), bone marrow transplantation (OR 1.79; 95% CI 1.19-2.70), and dialysis (OR 1.36; 95% CI 1.05-1.77). There was no association of arterial catheter complications with patient gender, Medicaid status, or presence of coagulopathy or shock.
Conclusions: Complications associated with arterial catheterization are common in critically ill children. Significantly, we were unable to account for the potential confounding effect of central venous catheterization in this study secondary to limitations of ICD-9 coding. This study serves as a hypothesis-generating report of a large pediatric sample and suggests the need to carefully assess arterial catheter-associated complications in a prospective study independent of central venous catheters.
Arterial catheters are commonly used in the pediatric intensive care unit (PICU) to facilitate continuous blood pressure monitoring and frequent sampling of blood. However, arterial catheters are not without complications. Studies in adults have found that complications occur in as many as 10% of arterial catheterizations. For example, Frezza and Mezghebe, in a study of nearly 5,000 adults, found that 3.0% to 4.6% of adult intensive care unit (ICU) patients with arterial catheters had vascular insufficiency related to the catheter. An additional 2% to 3% had bleeding and 1% had infection. Overall, 10% to 13% of patients had complications associated with arterial catheter placement. Another study of 93 adult ICUs in Australia found that approximately one in five patients with arterial catheter complications suffered an injury, from either ischemia, bleeding, or infection. In this study, most of the human risk factors for complications were knowledge and rule-based errors. In adult postoperative cardiac surgery patients, infection occurred in about 0.2% of arterial catheters. Although multiple adult studies have demonstrated abnormal arterial flow or occlusion after removal of arterial catheters, the frequency of ischemic damage in those studies was extremely low.
There have been few studies of arterial catheter complications in children, and most of these have been in neonates or infants. No study has examined a large patient population or examined risk factors for complications in children with arterial catheters. This study was conducted to determine the frequency of and risk factors for complications associated with arterial cannulation in the pediatric age group.
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