Arterial Lines in Pediatric Medicine
Arterial Lines in Pediatric Medicine
Introduction
Arterial lines (A-lines) are essential vascular access devices used in pediatric critical care for continuous blood pressure monitoring and frequent blood sampling. These indwelling catheters provide real-time hemodynamic data crucial for managing critically ill children.
Key Points
- Continuous real-time blood pressure monitoring
- Accurate measurement in hypotensive states
- Enables frequent blood sampling without repeated punctures
- Essential for titrating vasoactive medications
- Critical for managing ventilated patients
Common Indications
- Hemodynamic instability
- Shock states (all types)
- Major surgical procedures
- Respiratory failure requiring mechanical ventilation
- Frequent blood gas analysis needs
- Administration of vasoactive medications
Types and Equipment
Catheter Specifications
- 24G (neonates and small infants)
- 22G (infants and small children)
- 20G (larger children)
- Length: 2.5-5 cm based on size
Essential Equipment
- Arterial catheter set
- Pressure transducer system
- Monitoring cables
- Heparinized saline flush (0.5-1 unit/mL)
- Sterile dressing materials
- Local anesthetic (if applicable)
Common Sites
- Radial artery (most common)
- Posterior tibial artery
- Dorsalis pedis artery
- Femoral artery (emergency situations)
- Brachial artery (less preferred)
Insertion Procedure
Pre-procedure Assessment
- Allen's test for radial artery
- Coagulation status check
- Site selection based on anatomy
- Informed consent
Insertion Steps
- Position patient appropriately
- Perform surgical hand hygiene
- Use complete sterile barrier precautions
- Prepare skin with chlorhexidine
- Local anesthetic administration if indicated
- Cannulation using selected technique
- Secure catheter and apply sterile dressing
- Connect to pressure monitoring system
- Verify placement with waveform analysis
Documentation Requirements
- Site of insertion
- Catheter size and type
- Number of attempts
- Complications if any
- Patient tolerance
- Post-procedure perfusion status
Monitoring and Maintenance
Daily Care
- Hourly site inspection
- Assessment of perfusion
- Waveform quality check
- System calibration
- Dressing integrity verification
Infection Prevention
- Strict aseptic technique for all manipulations
- Regular chlorhexidine cleaning
- Dressing changes every 7 days or when soiled
- Minimal port access
- Daily necessity assessment
Troubleshooting
- Dampened waveform assessment
- Air bubble removal
- Catheter patency checks
- Position-related issues
- Perfusion concerns
Complications and Management
Immediate Complications
- Arterial spasm
- Hematoma formation
- Bleeding
- Nerve injury
- Failed cannulation
Delayed Complications
- Infection (local/systemic)
- Thrombosis
- Ischemia
- Arterial occlusion
- Skin necrosis
Prevention Strategies
- Regular assessment protocols
- Early recognition of complications
- Proper securing techniques
- Maintaining optimal flow
- Prompt removal when no longer needed
