INTRODUCTION: In the pediatric intensive care unit (PICU), arterial catheters are commonly placed for hemodynamic surveillance and/or sampling blood. Although uncommon, these catheters have complications including occlusion, bleeding, and infections. Incidence and risk factors of these complications have not been reported in a large pediatric multicenter study in many years. We aim to describe the current incidence of arterial catheter complications in the Virtual Pediatric Systems (VPS) database, which prospectively collects quality-controlled data from all admissions to >100 participating PICUs.
METHODS : With IRB approval, we queried VPS for children < 18 years of age who underwent (non-umbilical) arterial catheterization between 2016-2021 for demographics (including age as categorical variable), illness factors, and complications assigned to an arterial catheter. Factors associated with complications were analyzed using Chi-square (categorical variables) and Mann-Whitney U (continuous variables) testing. Data reported as n (%) or median (IQR), and p < 0.05 deemed statistically significant.
RESULTS: We identified 119,277 PICU patients with arterial catheters, and 3,818 complications that occurred in 3,736 patients (3.1%). The most common complication were non-function (n=1,210), dislodgement (n=636), thrombosis (n=320), and “other” (n=1,008). Bleeding (n=156) and infection (n=27) were uncommon. Complication rates varied significantly by age category, with the highest rate among children < 29 days old (5.8%). Complications were also more common in medical vs post-operative patients (4.8% vs 2.3%; p< 0.001) and cardiac vs non-cardiac patients (3.4% vs 3.0%, p=0.005). Patients with complications had longer length of stay (9.2 [3.4-22.2] vs 3.0 [1.2-7.8] days; p< 0.001) and increased mortality (12.3% vs 7.5%, p< 0.001)
CONCLUSIONS: Our large database study shows a 3% rate of complications associated with arterial catheters, with mechanical issues multiple times more common than hematologic or infectious ones, and higher rates in neonates and non-surgical patients. Given the association of complications with unfavorable clinical outcomes, risks should be considered before arterial catheterization.