title: Long sheath use in femoral artery catheterizations in infants <15 kg is associated with a higher thrombosis rate: Proposed Protocol for Detection and Management.
abstract: OBJECTIVE
  To examine the factors contributing to arterial thrombosis after catheterization, particularly the use of long vs. short introducer sheaths, and propose a new protocol to address risks.
  
  
  BACKGROUND
  Post-procedure arterial compromise is an important concern in pediatric cardiac catheterizations. For certain interventional procedures, the use of a long sheath is necessary, however, the incidence of complications when using such sheaths has not yet been studied.
  
  
  METHODS
  This retrospective review includes patients <15 kg who underwent femoral artery catheterization at our institution from Feb 2006 to June 2014. The study examined 29 long sheath and 40 matched interventional short sheath cases. Data collected included age, weight, time to arterial access, total sheath duration, and arterial complications. The long sheath and short sheath groups, and confounding factors, were compared for complication rate.
  
  
  RESULTS
  The incidence of arterial compromise was 38% (11/29) in the long sheath group compared to 15% (6/40) for short sheaths (P = 0.029). Arterial thrombosis was documented by ultrasound, CT, or angiography in 71% (12/17) patients. Time to arterial access and total sheath duration were not statistically significant factors. Weight was an independent risk factor, with infants <5 kg having a higher complication rate compared to infants >5 kg at 38.2% (13/34) and 11.4% (4/35), respectively (P = 0.004). Sheath length remained statistically significant after taking weight and age into account (P = 0.011).
  
  
  CONCLUSIONS
  The use of a long sheath in infants <15 kg is a significant risk factor for arterial compromise compared to short sheaths. Lower patient weight is also a contributing factor to increased incidence of complication, particularly in those <5 kg. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of California, San Diego, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Ding
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of California, San Diego, USA.|Department of Pediatrics, Division of Cardiology, Rady Children's Hospital, San Diego, USA.
authors.forename: Charissa
authors.initials: C
authors.lastname: Pockett
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of California, San Diego, USA.|Department of Pediatrics, Division of Cardiology, Rady Children's Hospital, San Diego, USA.
authors.forename: John
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of California, San Diego, USA.|Department of Pediatrics, Division of Cardiology, Rady Children's Hospital, San Diego, USA.
authors.forename: Howaida
authors.initials: H
authors.lastname: El-Said
mesh_terms: D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D001835:Body Weight; D002140:California / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002675:Child, Preschool; D002985:Clinical Protocols; D000072226:Computed Tomography Angiography; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D018608:Ultrasonography, Doppler; D062666:Vascular Access Devices
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator
keywords: catheterization adverse events; catheterization complications; femoral artery thrombosis; leg discrepancy; pediatric catheterization; tPA; thrombolytic therapy