This document discusses arterial catheterization in pediatrics. It outlines the objectives, which are to recall indications and contraindications for arterial catheterization, name complications, describe insertion sites and landmarks, and identify appropriate catheter sizes. Indications include blood sampling for oxygenation, ventilation, and frequent monitoring. Contraindications include collateral circulation issues and infections. Complications can include spasms, thrombosis, embolisms, hemorrhage, infections, skin necrosis, fistulas, and aneurysms. Potential insertion sites are the radial, ulinary, axillary, dorsalis pedis, posterior tibial, and femoral arteries. Anatomy, landmarks, and positioning are reviewed for each site.

1. Pediatrics
Vascular Access
PART DEUX: Arterial Catheterization

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Objectives
•By the end of this workshop, the learner will be able to:
‐Recall at least 3 indications and 3 contraindications for
arterial catheterization
‐Name at least 5 complications associated with arterial
catheterization
‐Describe the anatomic landmarks used to guide arterial
catheterization at specified sites of insertion
‐Identify the potential sites for arterial catheterization
‐Choose the appropriate sized vascular catheter according to the
patient’s size

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Pediatrics
Indications
•Arterial blood sampling
‐Oxygenation
‐Ventilation
•Frequent blood sampling
•Continuous monitoring of blood pressure

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Contraindications
•Known deficiencies of collateral circulation
•Infection at site of insertion
•Trauma injury
•Coagulopathy

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Complication
•Arterial spasm
•Thrombosis
‐Mottling proximal/distal
to catheter site
•Emboli
•Hemorrhage
‐Axillary sheath
hematoma
•Infection
‐Low incidence
•Skin necrosis
•Fistula
•Aneurysm
•Brachial plexus injury

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Sites of insertion
•Radial/Ulnar
•Axillary
•Dorsalis pedis
•Posterior tibial
•Femoral

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•Anatomy
•Surface Landmarks
•Positioning

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Radial
•Most common site
•Lies in longitudinal
groove formed by FCRM
and distal radius
•Check for collateral flow
•Thrombosis is common

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Axillary
•Large artery
•Excellent collateral flow
•Air/thrombus embolism
can cause brain/hand
ischemia

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Femoral
•Also large artery
•May still be palpable
with marked
hypotension
•Lack of collateral flow
•Air/thrombus embolism
can cause foot/toe
ischemia

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Dorsalis pedis
•Descends down dorsum
of foot parallel & lateral
to EHLT
•Check for collateral flow
‐Occlude artery
‐Blanch great toe for several
seconds
‐Release pressure &
observe for flushing

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Posterior tibial

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•Confirm via pressure transduction
•Tubing used for pressure monitoring should include
a Luer-lock design
•Papaverine-containing heparin solution prolongs
arterial catheter life
•If you cannot transduce……

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TAKE IT OUT!!!
TAKE IT OUT!
TAKE IT OUT!!