(825) Practice Patterns of Arterial Catheter Placement in the Pediatric Intensive Care Unit

Introduction: Best practice for arterial catheter (AC) placement in pediatric intensive care units (PICUs) is not well-established. This study aims to characterize AC placement practices.

Methods: A web-based, cross-sectional survey was distributed via email, and data was collected via snowball sampling. Responses were analyzed using descriptive statistics as well as a Kruskal-Wallis test to compare Likert scale responses across different groups.

Results: There were 204 responses from 72 different institutions. Respondents were primarily attending physicians (145/204, 71.7%), followed by fellows (42/204, 20.6%), and advanced practice providers (14/204, 6.9%). The radial artery was the most preferred site for peripheral ACs (72/188, 38.3%), followed by the ulnar artery (67/188, 35.6%) and the posterior tibial artery (46/188, 24.5%). Most (134/188, 71.3%) respondents agree or strongly agree that the ulnar artery is safe site for ACs.

Ultrasound is commonly used, with 163/204 (80%) of respondents reporting using ultrasound most of the time or always. Fellows are more likely than attendings to report using an ultrasound (p = 0.01); however, there is no significant difference between attendings or fellows regarding whether fellows should learn to place ACs without ultrasound (p = 0.78). Seldinger technique was the preferred method of placement (158/188, 84%), compared to direct puncture. While all participants use a topical antiseptic for placement, 173/188 (92%) use sterile gloves and 153/188 (81.4%) use a sterile drape.

The majority (115/188, 61.2%) agree or strongly agree that arterial catheters are potential sources of blood stream infections; however, 32.4% (61/188) disagree or strongly disagree. Fellows are more likely to consider arterial catheters a potential source of bacteremia (p < 0.01) compared to attendings. Most participants agreed or strongly agreed that the brachial artery was not a safe site for cannulation (117/188, 62.2%).

Conclusions: There is substantial variability in arterial catheter placement practices, even in areas with practice recommendations, such as procedural sterility and the safety of brachial cannulation. Further studies are needed to determine optimal placement practices for ACs in the PICU population.