Double-blind, randomized, controlled trial of papaverine-containing infusions to prevent failure of arterial catheters in pediatric patients

Abstract

To test the efficacy of the continuous infusion of papaverine-containing fluids into peripheral arterial catheters for reducing the risk of catheter failure. Prospective, double-blind, randomized, controlled trial. Pediatric intensive care unit in a children's hospital. A total of 239 children, aged 3 wks to 18 yrs who had an arterial catheter inserted for clinical purposes. Patients were randomized to receive either papaverine (60 mg/500 mL) or no additive, within the infused fluids. Data about patient demographics and potential risk factors for arterial catheter failure were collected at the time of catheter insertion, throughout the life of the catheter, and at the time of catheter removal. Catheter failure was defined as an inability to draw blood from the catheter or loss of the arterial waveform. Overall, 35 (15%) subjects had catheter failure. The risk of catheter failure was lower in patients randomized to receive papaverine (eight [7%] of 115 vs. 27 [22%] of 124; chi-square = 5.2; p = .02), and the time until failure of the catheter was longer in the papaverine group (p = .02, log-rank test). This difference persisted when controlling for potentially confounding factors. In critically ill children, infusion of papaverine-containing fluids reduces the risk of failure of peripheral arterial catheters.