title: Utility of intravenous catheters for femoral arterial cannulation in infants having complicated sternal re-entry.
abstract: OBJECTIVE
  Many children undergoing surgery for congenital heart disease have had prior operations. Reoperative sternotomy carries with it the risk of cardiac injury and the need for emergency peripheral cannulation. Unfortunately, in smaller children, many of the standard sites are occluded, stenosed, or too small for the smallest manufactured cannulas. Using a model, we evaluated the feasibility of using peripheral intravenous catheters for establishing cardiopulmonary support.
  
  
  METHODS
  A model cardiopulmonary bypass circuit was created. Catheters of varying diameter and length were used to simulate arterial cannulation. With each catheter, flows were incrementally increased until a maximum arterial line pressure was achieved. Data were recorded.
  
  
  RESULTS
  Catheter diameters increased from 24 to 14 gauge, and catheter lengths increased from 1 inch to 1.88 inches. Flow could not be established through the 24-gauge catheter without an unacceptably high arterial line pressure. From the next smallest catheter (22 gauge x 1 inch) to the largest catheter (14 gauge x 1.88 inches), maximum achievable flow rates ranged from 70 to 540 mL/min, respectively.
  
  
  CONCLUSIONS
  Peripheral arterial cannulation may be lifesaving in cases of complicated sternal re-entry in children. Intravenous catheters can be used when vessels are too small for standard cannulas. Flow rates that provide adequate support while maintaining acceptable arterial line pressures are achievable with peripheral intravenous catheters until central cannulation can be accomplished safely.
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, Emory University, Atlanta, Ga, USA. brian_kogon@emoryhealthcare.org
authors.forename: Brian
authors.initials: B
authors.lastname: Kogon
authors.forename: Jordan
authors.initials: J
authors.lastname: Voss
authors.forename: Craig
authors.initials: C
authors.lastname: Villari
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
authors.forename: Kathy
authors.initials: K
authors.lastname: Spitzer
authors.forename: Marney
authors.initials: M
authors.lastname: Moore
authors.forename: Annmarie
authors.initials: A
authors.lastname: McGoldrick
authors.forename: Paul
authors.initials: P
authors.lastname: Kirshbom
authors.forename: Kirk
authors.initials: K
authors.lastname: Kanter
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation*; D005240:Feasibility Studies; D005263:Femoral Artery; D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D014680:Veins