Management of iatrogenic acute limb ischaemia in the paediatric intensive care unit population

Abstract

In the Paediatric Intensive Care Unit (PICU) an arterial line is often inserted in critically unwell children to allow for reliable blood pressure monitoring and access to arterial blood for point-of-care blood gas analysis and laboratory testing. However, arterial catheterisation is a procedure that carries the risk of serious complications including impaired tissue perfusion, thrombotic events and limb ischaemia.1 The typical clinical features of iatrogenic acute limb ischaemia (ALI) in PICU patients include: (1) pallor (pale discolouration, mottling, cyanosis), (2) perishingly cold (cold to touch, use of temperature probe), (3) pulseless (absent distal pulses in affected limb), and (4) 3As (increasing analgesia requirements, anxiety and agitation). Importantly, other classical features of ALI such as pain, paralysis and paraesthesia are less useful in a PICU setting where patients are often sedated and ventilated.