Practice Variation in Arterial Catheter Placement: A Survey of Pediatric Critical Care Practitioners

Abstract

Background

There is not a consensus in critical care medicine on when arterial catheters are indicated, nor is there evidence that ACs improve patient outcomes. There is wide variability in AC use across PICUs that is independent of illness severity.

Objective

To characterize arterial catheter placement practices among pediatric critical care clinicians and identify practice variability in techniques, indications, and attitudes.

Design

Anonymous, cross-sectional web-based survey.

Measurements and Main Results

Data were collected from 377 pediatric critical care practitioners across 93 institutions. The majority were attending physicians (n = 215, 57.0%) or fellows (n = 141, 37.4%). Ultrasound was always used for arterial catheter placement by 52.0% (196/377) of respondents, with fellows being more likely than attendings to use ultrasound (P = .005). The catheter-over-wire (Seldinger) technique was the most common insertion method (332/377, 88.1%). For site selection, the radial artery was preferred for peripheral placement (97.3%), and the femoral artery for central cannulation (81.1%). There was substantial variability in the reported indications for arterial catheter use, with 68.9% considering single vasoactive support as an indication.

Conclusions

This study demonstrates wide practice variation in arterial catheter placement among pediatric ICU clinicians, despite the existence of some practice guidelines. Future research should focus on addressing gaps in evidence, particularly around ultrasound-guided techniques and securement methods, to optimize practices and improve outcomes.