447 Risk factors for limb ischaemia during femoral arterial catheterisation in the neonatal intensive care unit

Published Date: 11th October 2021

Publication Authors: Turner L

Background
Intravascular arterial access is used during neonatal intensive care for continuous accurate monitoring of arterial blood pressure and for reliable blood gas measurements.

Common vascular access sites are the umbilical arteries (UAC) and some peripheral arteries. When these routes are not available, a femoral artery catheter can be inserted (FAC).

The leg has some protection against ischaemic injury during FAC insertion by the collateral arterial supply around the hip, but limb ischaemia is a risk. All intensive care procedures have associated risk and the risk and benefits of FAC insertion in an individual patient need to be considered before insertion.

Objectives
To review outcomes of FAC insertion in a single large neonatal unit over a 12 year period between 20/8/2008 and 11/5/2020 to identify which babies are at risk of limb injury.

Methods
The electronic patient record was used to identify all the neonatal patients who had a FAC insertion between 20/8/2008 - 11/5/2020. Data extracted included: patient demographics, details of the line insertion procedure, reasons for line removal, evidence of compromised limb circulation, and the occurrence of ischaemic injury. Each case of ischemic injury was further investigated.

Results
147 FACs were inserted.

All patients were ventilated at the time of the insertion, and 78% were also receiving inotropes.

Impaired limb perfusion occurred in 32 (21%) patients. This recovered when the line was removed in most cases. The risk of impaired limb perfusion was greater with lower weight at the time of insertion.

In 6 babies the impaired perfusion did not recover and injury was sustained. In all cases there was evidence of a delay in the recognition of impaired perfusion and therefore a delay in removal. 2 babies had an associated cause of intraluminal arterial obstruction (co-existing UAC, non occlusive aortic thrombus) and 2 others had previous concerns about limb perfusion that were thought to have resolved at the time of FAC insertion.

Conclusions
FAC insertion can enhance the clinical care that babies receive in the Neonatal Intensive Care Unit. Emphasis should be on appropriate patient selection for the procedure, and rapid response to any evidence of vascular compromise with immediate line removal. Smaller babies and babies with other co-existing causes of impaired limb perfusion appear to be at highest risk of injury and the risks may outweigh the benefits in these babies.

Turner, L et al. (2021). 447 Risk factors for limb ischaemia during femoral arterial catheterisation in the neonatal intensive care unit . Archives of Disease in Childhood. 106 (Suppl 1), A19-A20

 

 

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