Ultrasound-guided radial artery cannulation in pediatric surgical patients <24 months of age

Abstract

Background: Arterial cannulation is increasingly becoming the standard of care in the perioperative management of complex pediatric surgeries and in patients with congenital cardiac anomalies. These indwelling arterial cannulas are used for invasive blood pressure (IBP) monitoring and blood gas analysis. With advent of ultrasound era, there is rising interest for its application in pediatric arterial cannulation. However, limited literature is available on its benefit in terms of success rate and complications. Aims: The aim of this study is to assess the success rate and complications when ultrasound guidance was used for arterial line insertion in the pediatric surgical patients. Setting and Design: Operation Theatre of Tertiary Care Centre / Prospective Observational Study. Statistics: Descriptive statistics. Materials and Methods: This study was conducted in children aged below 24 months requiring IBP monitoring during surgery. Parameters observed included rate of successful cannulation subdivided into first attempt success rate, successful cannulation within first two attempts, time to successful cannulation, and number of cannula. Complications namely hematoma and ischemic damage were also documented. Results: A total of 258 children were included in this study. We achieved successful radial artery cannulation in 95.74% patients, of which 77.9% were in first attempt while 8.1% required two attempts. The median time taken was about 168 s. In 33 (13%) cases, the site was changed before pricking based on thrombus or very narrow diameter of the artery. Hematoma formation was seen in 21 (8.1%) children, and only 2 (0.7%) children had features of ischemia in the distal part requiring removal of the cannula from radial artery. Conclusions: This study emphasized benefits of routine use of ultrasound in terms of higher chances of first-attempt success, lesser time for cannulation, lesser time taken, and more objective training benefit from ultrasound-guided radial artery cannulation in pediatric patients less than 24 months of age.