196 PERCUTANEOUS PERIPHERAL ARTERIAL CANNULATION (PPAC) IN NEONATES

Abstract

Percutaneous peripheral arterial cannulation was performed in 66 neonates with birth weight ranging from 560 gm to 4500 gms (15 - <1500 gm, 9-<1000 gm). Forty patients (pts) were admitted because of RDS, 23 with congenital heart disease. Twenty-two gauge Medicut intravenous cannula was placed percutaneously in radial (62 cases) or posterior tibial arteries (4 cases) by neonatologists in 16, by neonatal fellows in 27 and by surgeons in 23 pts. Cannula was connected to pressure transducer for continuous blood pressure and arterial wave form monitoring. Arterial lines were infused with 0.9% NaCl with 1 unit heparin/ml using continuous infusion pump. Average successful performance rate was one per 3 attempts (range 1 to 6 trials). Overall duration of cannulation ranged from 8 hours to 505 hrs (21 days). Cannulation was discontinued electively (no longer needed) in 38/63 (60.3%), infiltrated in 21/63 (33.3%) and clotted in 4/63 (6.3%) cases. Mean duration of cannulation was 100 hours (13–505 hrs) in electively discontinued lines, 91.5 hrs (8–373 hrs) in infiltrated and 59.3 hrs 46.5–76 hrs) in clotted lines. Transient ischemia of fingers was noted in 3 and skin necrosis in 1 patient. No other complication of arterial line was experienced. PPAC results in less complications than does UA catheterization. It carries no thromboembolic risk to internal organs. It may be perferable to UA catheterization. With practice, the technique is not more difficult than UA catheterization.