Immediate complications and risk factors following radial arterial catheterisation in paediatric patients at a tertiary centre.

Background: Arterial catheterisation is a critical procedure in paediatric patients undergoing surgery; however, it poses certain risks. Complications such as thrombus formation, arterial stenosis and haematoma may occur, yet their true incidence and contributing factors remain incompletely understood.

Objective: To assess the incidence of complications and identify associated risk factors following radial arterial catheterisation in paediatric patients.

Design: Prospective observational study.

Setting: A tertiary children's hospital.

Patients: Children aged 5 years or younger who are scheduled for elective surgery.

Intervention: Radial artery cannulation was performed under ultrasound guidance. The diameter of the artery and procedural details were recorded. Peripheral perfusion index was continuously monitored in both hands. Ultrasonographic assessments were conducted immediately after catheter removal, at 24 h postremoval and on postoperative day 5, to evaluate arterial status.

Main outcome measures: The primary outcome was the incidence of complications associated with arterial catheterisation after decannulation, assessed using ultrasonography. Secondary outcomes included the associated risk factors and the association between perfusion index changes and complications.

Results: Immediate complications after decannulation, including thrombus formation and significant arterial stenosis, were observed in 41.5% of patients, as assessed by ultrasound. Risk factors for complications included a higher Medicut™-to-artery diameter ratio: odds ratio (OR) 25.3 (95% confidence interval [CI], 1.2 to 350.7) P = 0.002, and longer anaesthesia duration: OR 1.008 (95% CI, 1.002 to 1.015) P < 0.001. Perfusion index values were not associated with immediate complications. At 24 h postdecannulation, patients who had immediate complications still exhibited a greater arterial size reduction. By postoperative day 5, arterial diameters had spontaneously improved significantly, and no clinical complications were observed.

Conclusion: Most immediate complications following radial arterial catheterisation in paediatric patients resolved spontaneously by postoperative day 5. The Medicut-to-artery diameter ratio and prolonged anaesthesia were significant risk factors for complications.

Clinical trials registration: ClinicalTrials.gov, NCT03784118.