Background:
Arterial lines (A-line) insertion is a routinely performed procedure in intensive care units and operation rooms. The manufacturer’s recommendation is to keep the external pressure at about 300 mmHg. However, to keep the pressure at such level can be hazardous to pediatric patients. The literature about the impact of keeping lower pressure is limited. Thus, we conduct a retrograde cohort study to explore this topic.
Material and methods:
We retrospectively reviewed patients who received radial arterial cannulation in a pediatric intensive unit from July 2007 to July 2008. During this period, nursing routine was changed by nursing administrations at February 2008. The pressurized bag level was reduced from 300 mmHg to 200 mmHg. Kaplan-Meier survival analysis was applied for A-line clot and all causes A-line survival. Cox regression model was applied for searching potential confounding factors.
Results:
During the study period, 123 A-lines with pressure 300 mmHg and 98 A-lines with pressure 200 mmHg were recorded. The mean survival time for A-line clot was 10.0 and 24.0 days for 300 and 200 mmHg groups. The difference was statically significant. When analyzing all-causes A-line survival, the mean survival time is 6.7 days and 13.6 days for 300 and 200 mmHg groups. It also reached statistically significant.
Conclusion:
Keeping lower pressure in the pressurized bag might be a safe and efficient alternative. It can reduce the potential central nervous system hazard and the cost of maintaining A-line system for pediatric patients. Further randomized trials might be needed to confirm it.