Femoral Vascular Catheterization in Critically Ill Infants and Children

Abstract

The success rate and complications from femoral arterial and venous catheterization in infants and children in a university affiliate pediatric intensive care unit were determined prospectively over a 2-year period. We also performed a meta-analysis from published literature to determine the combined estimates of noninfectious and infectious complications (with 95% con fidence limits) using the inverse variance-weighted method. Success rates were 94.5% and 94.4% for femoral arterial (n=110) and venous (n=89) catheterizations, respectively, and were related to operator expertise, age, and hemodynamic status. Median age was 2.4 years and 1.1 year for arterial and venous catheterizations, respectively. Immediate complications were hematoma (10.9% arterial, 16.8% venous) and minor bleeding (13.6% arterial, 13.5% venous). Decreased pulses occurred with 7.7% of arterial catheterizations, and lower limb swelling occurred in 9.5% of venous catheteriza tions. Vascular complications occurred only in infants and resolved within 7-14 days. Catheter- related infections occurred in 1.9% of arterial and 3.6% of venous catheterizations. The mean dura tion of catheterization was 5.3 days and 6.3 days with femoral arterial and venous catheterizations, respectively. Meta-analysis of published studies shows that the estimates for noninfectious compli cations were 5.0%, 10.1 %, 1.1%, and 1.8% for femoral arterial, femoral venous, axillary arterial, and nonfemoral venous catheters, respectively. The estimates for catheter-related infection were 2.5%, 3.7%, and 3.0% for femoral arterial, femoral venous, and nonfemoral venous catheters, respectively. The meta-analytic estimates for complication rates from published literature are not significantly different from the rates observed in our study. Femoral arterial and venous cathe terization in infants and children are safe with an expected high success rate and acceptably low complication rates.