FEMORAL VASCULAR CATHETERIZATION IN CRITICALLY-ILL INFANTS AND CHILDREN

The success rate and complications from femoral arterial and venous ca theterization in infants and children in a university affiliate pediat ric intensive care unit were determined prospectively over a 2-year pe riod. We also performed a meta-anal)Isis from published literature to determine the combined estimates of noninfectious and infectious compl ications (with 95% confidence limits) using the in verse variance-weig hted method. Success rates were 94.5% and 94.4% for femoral arterial ( n = 110) and venous (n = 89) catheterizations, respectively, and were related to operator expertise, age, and hemodynamic status, Median age was 2.4 years and 1.1 year for arterial and venous catheterizations, respectively. Immediate complications were hematoma (10.9% arterial, 1 6.8% venous) and minor bleeding (13.6% arterial, 13.5% venous). Decrea sed pulses occurred with 7.7% of arterial catheterizations, and lower limb swelling occurred in 9.5% of venous catheterizations. Vascular co mplications occurred only in infants and resolved within 7-14 days. Ca theter-related infections occurred in 1.9% of arterial and 3.6% of ven ous catheterizations. The mean duration of catheterization was 5.3 day s and 6.3 days with femoral arterial and venous catheterizations, resp ectively. Meta-analysis of published studies shows that the estimates for noninfectious complications were 5.0%, 10.1%, 1.1%, and 1.8% for f emoral arterial, femoral venous, axillary arterial, and nonfemoral ven ous catheters, respectively. The estimates for catheter-related infect ion were 2.5%, 3.7%, and 3.0% for femoral arterial, femoral venous, an d nonfemoral venous catheters, respectively. The meta-analytic estimat es for complication rates from published literature are not significan tly different from the rates observed in our study. Femoral arterial a nd venous catheterization in infants and children are safe with an exp ected high success rate and acceptably low complication rates.