COMPLICATIONS OF ARTERIAL CATHETERS - RETROGRADE FLOW AND HYPERTENSIVE PEAKS

Abstract

Arterial catheters are now an integral part of intensive care medicine & provide the capacity for continuous blood pressure measurement & the ability to perform frequent blood gases. However these catheters potentially have a number of complications including infection, hemorrhage, ischemia & embolisation. We investigated whether retrograde flow occurs with routine flushing of these catheters & if so whether it was associated with alterations of blood pressure at sites distal to the flushing point. We studied 14 patients whose weights ranged from 680-4180 g, gestation 24-41 wks, day to study 1-60 with 5 radial, 7 umbilical & 2 posterior tibial catheters. On flushing of the catheter with saline, following routine blood gas, ultrasound exam showed retrograde flow of "microbubbles" into the aortic arch, carotid artery & superior mesenteric in all patients. Also, pressure transmission was recorded with increases in peak systolic & diastolic pressures of 5.7-40% above basal lines. Variability of pressure transmission depended on the volume and speed of injection with respect to the phase of the cardiac cycle, & the intrinsic flow characteristics of the particular infant. Both retrograde flows of saline ± fibrin aggregates, & hypertensive peaks may have important implications in the pathogenesis of intraventricular hemorrhage & necrotising enterocolitis. With low volume (0.5 cc) + slow injection ( 10sec) neither "microbubbles" were seen, nor pressure transmission recorded.

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