Utility of intravenous catheters for femoral arterial cannulation in infants having complicated sternal re-entry

Abstract

Many children undergoing surgery for congenital heart disease have had prior operations. Reoperative sternotomy carries with it the risk of cardiac injury and the need for emergency peripheral cannulation. Unfortunately, in smaller children, many of the standard sites are occluded, stenosed, or too small for the smallest manufactured cannulas. Using a model, we evaluated the feasibility of using peripheral intravenous catheters for establishing cardiopulmonary support. A model cardiopulmonary bypass circuit was created. Catheters of varying diameter and length were used to simulate arterial cannulation. With each catheter, flows were incrementally increased until a maximum arterial line pressure was achieved. Data were recorded. Catheter diameters increased from 24 to 14 gauge, and catheter lengths increased from 1 inch to 1.88 inches. Flow could not be established through the 24-gauge catheter without an unacceptably high arterial line pressure. From the next smallest catheter (22 gauge x 1 inch) to the largest catheter (14 gauge x 1.88 inches), maximum achievable flow rates ranged from 70 to 540 mL/min, respectively. Peripheral arterial cannulation may be lifesaving in cases of complicated sternal re-entry in children. Intravenous catheters can be used when vessels are too small for standard cannulas. Flow rates that provide adequate support while maintaining acceptable arterial line pressures are achievable with peripheral intravenous catheters until central cannulation can be accomplished safely.