Peripheral arterial lines in the picu: An observational study of device complications and failure

Abstract

AIMS & OBJECTIVES: To examine the freuquency and risk factors for peripheral arterial catheter (PAC) complications and failure in the paediatric intensive care unit (PICU). METHODS: A prospective, observational study was conducted in the anaesthetic department and paediatric intensive care unit of a tertiary paediatric facility in Australia. We included children requiring a PAC and PICU admission following surgery. Data were collected on clinical and demographic characteristics as well as device insertion, management and complication data. Standard incidence and prevalence were calculated per 1,000 device days. Risk factors for PAC failure were identified using Cox regression. RESULTS: A total of 89 children and 100 PACs were examined, capturing 472 device days. Twenty percent (n = 19) of PACs failed prior to treatment completion with an IR of 40.2 per 1000 catheter days (95% CI 25.7 - 63.1). Fourteen required re-insertion (70%). Median dwell time was 50.6 hours (interquartile range [IQR] 24.0-158.0) with poor trace (10 PACs; 11%) or blockage (6 PACs; 6%) the primary reasons for PAC failure. A higher PIM3 score (HR 1.06; 95% CI 1.03-1.09; p < 0.01) and arm board immobilisation (HR 2.9; 95% CI 1.02-8.02; p = 0.05) was associated with an increased the risk of PAC failure; while non-2% chlorhexidine antisepsis was associated with a decrease in PAC failure (HR 0.32; 95% CI 0.11-0.96; p = 0.04), in univariate analysis. CONCLUSIONS: PAC is failure is common, often necessitating repeat PAC insertion. Prospective clinical trial data is needed to develop interventions which prevent PAC failure in the PICU.L6347734882021-04-21 <br />