{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:30:16Z","timestamp":1789763416396,"version":"4.0.1"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Peripheral arterial line placement is a common, low-risk procedure in pediatric patients undergoing cardiac surgery. Central arterial cannulation may be used when peripheral cannulation is not feasible. At present, there are limited data to guide central arterial-line site selection in pediatric patients. We aimed to (1) quantify the rate of complications associated with central arterial-line placement in pediatric patients undergoing cardiac surgery, (2) determine risk factors associated with central arterial-line complications, and (3) describe placement trends during the last decade.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n This was a retrospective, single-center cohort study of pediatric patients who underwent intraoperative placement of an axillary or femoral arterial line for cardiac surgery between July 1, 2012 and June 30, 2022. The primary outcome studied was the incidence of complications, defined as vascular compromise, pulse loss, ultrasound-confirmed thrombus or flow abnormality, and\/or positive blood cultures not attributable to another source. Patients\u2019 characteristics and perioperative factors were analyzed using univariate and multivariate analysis to examine the relationship between these factors and line-associated complications.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n A total of 1263 central arterial lines were analyzed\u2014195 axillary arterial lines and 1068 femoral arterial lines. The overall incidences of vascular compromise and pulse loss from central arterial-line placement were 17.8% and 8.3%, respectively. Axillary lines had lower rates of vascular compromise (6.2% vs 19.9%,\n P<\/jats:italic>\n < .001), pulse loss (2.1% vs 9.5%,\n P<\/jats:italic>\n < .001), and ultrasound-confirmed thrombus of flow abnormalities (14.3% vs 81.1%,\n P<\/jats:italic>\n = .001) than femoral lines. Complications were more common in neonates and infants. By multivariate logistic regression, femoral location (odds ratio [OR], 4.16, 95% confidence interval [CI], 1.97\u20138.78), presence of a genetic syndrome (OR, 1.68, 95% CI, 1.21\u20132.34), prematurity (OR, 1.48, 95% CI, 1.02\u20132.15), and anesthesia time (OR, 1.17 per hour, 95% CI, 1.07\u20131.27 per hour) were identified as independent risk factors for vascular compromise. Femoral location (OR, 7.43, 95% CI, 2.08\u201326.6), presence of a genetic syndrome (OR, 1.86, 95% CI, 1.18\u20132.93), prematurity (OR, 1.65, 95% CI, 1.02\u20132.67), and 22-G catheter size (OR, 3.26, 95% CI, 1.16\u20139.15) were identified as independent risk factors for pulse loss.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Axillary arterial access is associated with a lower rate of complications in pediatric patients undergoing cardiac surgery as compared to femoral arterial access. Serious complications are rare and were limited to femoral arterial lines in this study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1213\/ane.0000000000006972","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T17:49:46Z","timestamp":1719510586000},"page":"957-965","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Central Arterial Line Placement for Pediatric Cardiac Surgery: A Single-Center Experience"],"prefix":"10.1213","volume":"140","author":[{"given":"Katherine L.","family":"Zaleski","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Kuntz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Staffa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Van Pelt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Rebecca L.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas B.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"key":"R1-20250314","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/ALN.0000000000003594","article-title":"Major short-term complications of arterial cannulation for monitoring in children.","volume":"134","author":"Gleich","year":"2021","journal-title":"Anesthesiology"},{"key":"R2-20250314","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/cc1489","article-title":"Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine.","volume":"6","author":"Scheer","year":"2002","journal-title":"Crit Care"},{"key":"R3-20250314","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1365-2044.1984.tb09449.x","article-title":"Percutaneous arterial cannulation in children. Concurrent and subsequent adequacy of blood flow at the wrist.","volume":"39","author":"Marshall","year":"1984","journal-title":"Anaesthesia"},{"key":"R4-20250314","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/j.1460-9592.2004.01522.x","article-title":"Catheterization of the radial or brachial artery in neonates and infants.","volume":"15","author":"Schindler","year":"2005","journal-title":"Paediatr Anaesth"},{"key":"R5-20250314","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/ALN.0000000000001626","article-title":"Brachial arterial pressure monitoring during cardiac surgery rarely causes complications.","volume":"126","author":"Singh","year":"2017","journal-title":"Anesthesiology"},{"key":"R6-20250314","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1213\/ANE.0000000000000082","article-title":"Brachial artery catheterization: an assessment of use patterns and associated complications.","volume":"118","author":"Handlogten","year":"2014","journal-title":"Anesth Analg"},{"key":"R7-20250314","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1542\/peds.84.2.273","article-title":"Axillary arterial monitoring of pediatric patients.","volume":"84","author":"Lawless","year":"1989","journal-title":"Pediatrics"},{"key":"R8-20250314","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/0310057X8501300107","article-title":"Intravascular monitoring via the axillary artery.","volume":"13","author":"Brown","year":"1985","journal-title":"Anaesth Intensive Care"},{"key":"R9-20250314","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/00003246-199008000-00018","article-title":"Percutaneous catheterization of the axillary artery in the pediatric patient [published correction appears in Crit Care Med 1991 May;19(5):746].","volume":"18","author":"Cantwell","year":"1990","journal-title":"Crit Care Med"},{"key":"R10-20250314","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/BF01972974","article-title":"Cannulation of the axillary artery in critically ill newborn infants.","volume":"154","author":"Piotrowski","year":"1995","journal-title":"Eur J Pediatr"},{"key":"R11-20250314","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/00000542-198702000-00021","article-title":"A prospective evaluation of femoral artery monitoring in pediatric patients.","volume":"66","author":"Glenski","year":"1987","journal-title":"Anesthesiology"},{"key":"R12-20250314","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/PCC.0b013e3182192c7b","article-title":"Femoral artery catheterization in neonates and infants.","volume":"13","author":"Dumond","year":"2012","journal-title":"Pediatr Crit Care Med"},{"key":"R13-20250314","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1097\/00003246-199012000-00011","article-title":"Femoral artery cannulation for monitoring in critically ill children: prospective study.","volume":"18","author":"Graves","year":"1990","journal-title":"Crit Care Med"},{"key":"R14-20250314","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/j.1538-7836.2011.04271.x","article-title":"Incidence and predictors of indwelling arterial catheter-related thrombosis in children.","volume":"9","author":"Brotschi","year":"2011","journal-title":"J Thromb Haemost"},{"key":"R15-20250314","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1161\/01.CIR.82.5.1697","article-title":"Iliofemoral arterial complications of balloon angioplasty for systemic obstructions in infants and children.","volume":"82","author":"Burrows","year":"1990","journal-title":"Circulation"},{"key":"R16-20250314","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/ccd.20884","article-title":"Vascular ultrasound imaging to study immediate postcatheterization vascular complications in children.","volume":"68","author":"Kulkarni","year":"2006","journal-title":"Catheter Cardiovasc Interv"},{"key":"R17-20250314","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1002\/ccd.24737","article-title":"Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study.","volume":"82","author":"Glatz","year":"2013","journal-title":"Catheter Cardiovasc Interv"},{"key":"R18-20250314","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1002\/ccd.26702","article-title":"Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: a prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse.","volume":"88","author":"Alexander","year":"2016","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["Anesthesia & Analgesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000006972","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:28:13Z","timestamp":1786112893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000006972"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1213\/ane.0000000000006972","relation":{},"ISSN":["0003-2999","1526-7598"],"issn-type":[{"value":"0003-2999","type":"print"},{"value":"1526-7598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,27]]}}}