Axillary Arterial Lines in Pediatrics

[HalO'Thane]

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For those placing arterial lines in smaller pediatric patients, are you comfortable placing them in the axillary artery?

Today I had a 3 y.o., 14 kg female with severe spasticity scheduled for a bilateral derotational osteotomy. I was anticipating a decent amount of blood loss and she was pretty poor protoplasm to begin with (trach, chronic lung disease, former NICU baby) so I opted to place an arterial line. Even under general anesthesia with muscle relaxation she was so contorted that I could not extend her wrists to easily place a radial a-line. Because she was getting a SPICA cast a femoral a-line was out of the question. Using ultrasound I was able to visualize the axillary artery and cannulate it without much trouble.

I did a literature search about this and searched this forum. It seems like the axillary artery is fairly safe to use. There is much better collateral circulation compared to the brachial artery. I have read about cases of clot formation in adults but never read anything in kids. Even in small children the axillary artery can be pretty well visualized under ultrasound. If I am in a tough case and need to pop a quick a-line on a small, sick kid this may become my go to line as opposed to repeatedly poking around for a radial line or going in the groin.

Just wanted to know everyone's thoughts on this.

 

[imfrankie]

For those placing arterial lines in smaller pediatric patients, are you comfortable placing them in the axillary artery?

Today I had a 3 y.o., 14 kg female with severe spasticity scheduled for a bilateral derotational osteotomy. I was anticipating a decent amount of blood loss and she was pretty poor protoplasm to begin with (trach, chronic lung disease, former NICU baby) so I opted to place an arterial line. Even under general anesthesia with muscle relaxation she was so contorted that I could not extend her wrists to easily place a radial a-line. Because she was getting a SPICA cast a femoral a-line was out of the question. Using ultrasound I was able to visualize the axillary artery and cannulate it without much trouble.

I did a literature search about this and searched this forum. It seems like the axillary artery is fairly safe to use. There is much better collateral circulation compared to the brachial artery. I have read about cases of clot formation in adults but never read anything in kids. Even in small children the axillary artery can be pretty well visualized under ultrasound. If I am in a tough case and need to pop a quick a-line on a small, sick kid this may become my go to line as opposed to repeatedly poking around for a radial line or going in the groin.

Just wanted to know everyone's thoughts on this.

Agreed. I like dorsalis pedis and posterior tibs also.