Complications of Peripheral Arterial Access in Preterm and Term Neonates: A Systematic Review

Aims: To provide a comprehensive review of vascular complications secondary to peripheral arterial catheterisation in preterm and term neonates. Methods: The systematic review consisted of searching PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and references of journals using pre-trialled MeSH terms and articles. Results: Eight studies were included for full text analysis from 2369 initial articles: 6 retrospective reviews and 2 prospective studies. The rate of complication was 8.6% and all complications were ischemic in nature. Complications most often occurred in neonates with pulmonary/cardiac comorbidities and lower gestational ages. No association was found for weight and sex of neonates. The radial artery site presented with lower complication rates of 6% and the femoral presented with the highest (16%). Complications predominantly occurred in artery catheter sizes larger than 22G and most often within one day of insertion. A low rate of complications (7.4%) was observed in studies that used heparinised saline at time of catheterisation. Conclusion: This study demonstrates an increasing overall rate of complications with ischemia presenting as the most common complication. There seems to be an association between gestational age, comorbidities, site of catheter, size of catheter and duration of catheter with such complications. This study also demonstrates the association between the use of heparinised saline and a reduction in rate of complications. The authors advocate for a national data collection tool of all pediatric arterial catheters and its complications to be able to analyse and work on best practice in order to minimize life changing iatrogenic complications.