Long sheath use in femoral artery catheterizations in infants <15 kg is associated with a higher thrombosis rate: Proposed Protocol for Detection and Management.

OBJECTIVES: To examine the factors contributing to arterial thrombosis after catheterization, particularly the use of long vs. short introducer sheaths, and propose a new protocol to address risks.

BACKGROUND: Post-procedure arterial compromise is an important concern in pediatric cardiac catheterizations. For certain interventional procedures, the use of a long sheath is necessary, however, the incidence of complications when using such sheaths has not yet been studied.

METHODS: This retrospective review includes patients <15 kg who underwent femoral artery catheterization at our institution from Feb 2006 to June 2014. The study examined 29 long sheath and 40 matched interventional short sheath cases. Data collected included age, weight, time to arterial access, total sheath duration, and arterial complications. The long sheath and short sheath groups, and confounding factors, were compared for complication rate.

RESULTS: The incidence of arterial compromise was 38% (11/29) in the long sheath group compared to 15% (6/40) for short sheaths (P = 0.029). Arterial thrombosis was documented by ultrasound, CT, or angiography in 71% (12/17) patients. Time to arterial access and total sheath duration were not statistically significant factors. Weight was an independent risk factor, with infants <5 kg having a higher complication rate compared to infants >5 kg at 38.2% (13/34) and 11.4% (4/35), respectively (P = 0.004). Sheath length remained statistically significant after taking weight and age into account (P = 0.011).

CONCLUSION: The use of a long sheath in infants <15 kg is a significant risk factor for arterial compromise compared to short sheaths. Lower patient weight is also a contributing factor to increased incidence of complication, particularly in those <5 kg. © 2016 Wiley Periodicals, Inc.