Complications associated with arterial catheterization in children.
OBJECTIVE
To examine the prevalence of and risk factors associated with arterial catheterization complications in a large pediatric patient population in an effort to generate hypotheses for future prospective study of arterial catheter placement.


METHODS
Retrospective cohort study.


METHODS
Patients discharged between January 1, 2000, and March 31, 2005, from 33 children's hospitals belonging to the Child Health Corporation of America.


METHODS
Patients were 10,394 children identified from the Pediatric Health Information System database. Inclusion criteria included age 1 month to 18 yrs, admitted to a pediatric intensive care unit, received an arterial catheter for monitoring, and hospitalized for >or=1 day following catheter placement.


METHODS
None.


RESULTS
We assessed complications as defined by ICD-9 coding associated with arterial catheterization, including thrombosis, embolism, and infection. Complications were reported in 10.3% (1,072) of patients, most frequently infection/inflammation (61.8%), complication of vascular device not otherwise specified (14.9%), mechanical complications (14.1%), and embolic or thrombotic issues (7.5%). Independent predictors of complications associated with arterial catheterization were age (compared with 1-4 months) of 5-11 months (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.25-1.82) or 1-2 yrs (OR 1.39; 95% CI 1.09-1.78), insertion of catheters after the first hospital day and need for cardiac surgery (OR 1.31; 95% CI 1.03-1.68), bone marrow transplantation (OR 1.79; 95% CI 1.19-2.70), and dialysis (OR 1.36; 95% CI 1.05-1.77). There was no association of arterial catheter complications with patient gender, Medicaid status, or presence of coagulopathy or shock.


CONCLUSIONS
Complications associated with arterial catheterization are common in critically ill children. Significantly, we were unable to account for the potential confounding effect of central venous catheterization in this study secondary to limitations of ICD-9 coding. This study serves as a hypothesis-generating report of a large pediatric sample and suggests the need to carefully assess arterial catheter-associated complications in a prospective study independent of central venous catheters.
King
Mary A
MA
Children's Hospital and Regional Medical Center, Critical Care, Seattle, WA, USA. marypicu@gmail.com
Garrison
Michelle M
MM
Vavilala
Monica S
MS
Zimmerman
Jerry J
JJ
Rivara
Frederick P
FP
D000293:Adolescent; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors