Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients.
OBJECTIVE
To examine the patterns of usage and associated complications among radial, femoral, and ulnar artery catheters in the pediatric intensive care unit to ascertain the utility of the ulnar artery as an alternative vessel of peripheral cannulation.


METHODS
A 4-yr retrospective review of all admissions to the pediatric intensive care unit to identify all patients with ulnar, radial, or femoral arterial catheterization.


METHODS
Pediatric intensive care unit of a tertiary care pediatric center.


METHODS
A total of 124 critically ill pediatric patients (age, 0.4-36 mos) were identified.


METHODS
Ulnar and radial artery catheters were either 22 gauge or 24 gauge, femoral artery catheters were 2.5 Fr, 2.5 cm, or 3 Fr, 5 cm, in size. All catheters were percutaneously inserted. The ulnar artery was typically used when attempts at common peripheral sites were unsuccessful.


RESULTS
A total of 18 ulnar, 103 radial, and 69 femoral artery cannulations were identified. The ulnar artery catheter duration ranged from 1 to 19 days (mean, 4.2 +/- 4.2 days), radial artery duration ranged from 1 to 24 days (mean, 5.3 +/- 4.2 days), and femoral artery duration ranged from 1 to 21 days (mean, 6.9 +/- 4.5 days). Ischemia as the reason for catheter removal was 5.6%, 3.9%, and 8.7% for ulnar, radial, and femoral arterial catheters, respectively. The catheter-related infection rate was 0%, 0.97%, and 4.3% for ulnar, radial, and femoral arterial catheters, respectively.


CONCLUSIONS
Based on the ischemic and infectious complication rates, the ulnar artery should be considered as a viable site for peripheral vessel cannulation in cases in which arterial catheterization is necessary and attempts at more common sites of catheterization are unsuccessful.
Kahler
Allan C
AC
Department of Pediatrics, Division of Critical Care, The Children's Regional Hospital at Cooper Hospital and Robert Wood Johnson Medical School, Camden, NJ 08103-1489, USA. allan_kahler@yahoo.com
Mirza
Farrukh
F