Turner Lucy, Alexopolou Vasiliki, Tawfik Hanin Tawfik Mohammed, Silva Monica, Yoxall Charles William
Neonatal Unit, Liverpool Women's Hospital, Liverpool L8 7SS, UK.
Children (Basel). 2022 Aug 20;9(8):1259. doi: 10.3390/children9081259.
To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury.
Retrospective survey of data relating to all episodes of FAC insertion in a single neonatal intensive care unit over a 12 year period up to 2020.
146 FACs were inserted into 139 babies with a median (interquartile range) gestation and birth weight of 27 (24 to 37) weeks and 1092 (682 to 2870) g. Impaired limb perfusion occurred in 32 (22%). This was transient and recovered with no injury in 26 of the 32. There was an increased risk of impaired limb perfusion in babies with lower weight at the time of insertion; from 5.7% in babies over 3000 g to 34.7% in babies under 1000 g (relative risk 6.1 (1.5 to 24.6)). Six babies (4%) had ischaemic injury. Risk factors for ischaemic injury included weight below 1000 g (four cases), pre-existing partial arterial obstruction (two cases), concerns about limb perfusion prior to FAC insertion (two cases) and a delay in removing the FAC after recognition of the poor perfusion (five cases). Two clinicians inserted 71 (50%) FACs and had no associated injuries.
FAC can be used in neonates, although there is a risk of ischaemic injury, particularly in very small babies. Our data can be used to inform decisions about patient selection for this procedure.
为回顾在一个大型新生儿病房12年期间所有股动脉导管（FAC）插入操作的结果，我们将描述FAC插入引起的伤害发生率，并确定与缺血性损伤相关的危险因素。
对截至2020年的12年期间，在一个新生儿重症监护病房进行的所有FAC插入操作的数据进行回顾性调查。
对139名婴儿插入了146根FAC，中位（四分位间距）孕周和出生体重分别为27（24至37）周和1092（682至2870）克。32例（22%）出现肢体灌注受损。其中26例为短暂性，且恢复后未造成损伤。插入时体重较低的婴儿发生肢体灌注受损的风险增加；体重超过3000克的婴儿为5.7%，体重低于1000克的婴儿为34.7%（相对风险6.1（1.5至24.6））。6例（4%）婴儿发生缺血性损伤。缺血性损伤的危险因素包括体重低于1000克（4例）、既往存在部分动脉阻塞（2例）、FAC插入前对肢体灌注的担忧（2例）以及在认识到灌注不良后延迟拔除FAC（5例）。两名临床医生插入了71根（50%）FAC，且未出现相关损伤。
尽管存在缺血性损伤风险，尤其是在非常小的婴儿中，FAC仍可用于新生儿。我们的数据可用于为该操作的患者选择决策提供参考。
