Abstract
Purpose
To evaluate the risk of retrograde embolization of flush solution in neonates and infants with routinely used electronic syringe pumps and infusion bag pump flush systems.
Methods
With hospital Ethical Committee approval we studied intubated neonates and infants with a 24-GA radial arterial cannula. Fast flush boluses were delivered from the infusion bag pump flush system by opening the flow regulating device for two seconds at bag pump manometre pressures of 100, 200 and 300 mmHg. In the syringe pump flush system, fast flush bolus volumes of 0.5, 1.0, 1.5 and 2.0 mL were programmed on the electronic syringe pump and released by opening the flow regulating device for two seconds. A 12-MHz ultrasonic probe placed in the jugular fossa was used to detect white bubbles indicating retrograde embolization of flush solution into the ipsilateral subclavian and common carotid artery.
Results
Sixteen patients, aged from 1–105 days (median 22 days) were studied. In all patients retrograde embolization into the subclavian artery was detected at syringe pump bolus volumes of 0.5–1.5 mL and at 100–200 mmHg bag pump pressure. In nine of the 16 patients a positive signal was detected in the common carotid artery with 1.5–2.0 mL syringe pump bolus volumes and at 200–300 mmHg bag pump pressure.
Conclusions
In neonates and infants, the standard practice of arterial fast bolus flushing using syringe pump and bag pump flush systems causes retrograde embolization of flush solution into the central arterial and even into the cerebral circulation. The mandatory limitation of fast flush bolus volumes and manometre pressures is urgent in order to reduce retrograde embolization of flush solution and the associated risks in these small patients.
Résumé
Objectif
Évaluer le risque d’embolisation rétrograde de la solution de rinçage chez les nouveau-nés et les jeunes enfants causée par les systèmes de rinçage avec pompes à seringue électroniques et sacs à perfusion.
Méthode
Ayant obtenu l’approbation du Comité d’éthique de l’hôpital, nous avons pu étudier des nouveau-nés et des jeunes enfants Intubés avec une canule artérielle radiale de calibre 24. Des bolus de rinçage rapides ont été libérés par le système de rinçage d’un sac à perfusion en ouvrant le dispositif de régulation de débit pendant deux secondes pour des pressions manométriques du sac de 100, 200 et 300 mmHg. Dans le système de rinçage de pompe à seringue, des bolus rapides de 0,5, 1,0, 1,5 et 2,0 mL ont été programmés sur la pompe à seringue électronique et libérés pendant deux secondes. Une sonde à ultra-sons de 12 MHz placée dans la fosse jugulaire a permis de détecter les bulles Indiquant une embolisation rétrograde de la solution de rinçage dans les artères sous-clavière et carotide commune homolatérales.
Résultats
Seize patients, de I à 105 jours (moyenne de 22 jours) ont été étudiés. Chez tous les participants, une embolisation rétrograde a été détectée dans l’artère sous-clavlère pour des bolus de la pompe à seringue de 0,5 à 1,5 mL et des pressions de 100 et 200 mmHg du sac à perfusion. Chez 9 des 16 patients, un signal positif a été détecté dans l’artère carotide commune pour des bolus de 1,5-2, 0 mL et des pressions de 200–300 mmHg.
Conclusion
Chez les nouveau-nés et les jeunes enfants, le rinçage artériel habituel en bolus rapides avec des systèmes de rinçage avec pompe à seringue et sac à perfusion cause une embolisation rétrograde de la solution de rinçage dans la circulation artérielle centrale et même cérébrale. Il est urgent de limiter les rinçages en bolus rapides et les pressions au manomètre afin de réduire l’embollsatlon rétrograde de la solution de rinçage et les risques associés.
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Weiss, M., Balmer, C., Cornelius, A. et al. Arterial fast bolus flush systems used routinely in neonates and infants cause retrograde embolization of flush solution into the central arterial and cerebral circulation. Can J Anesth 50, 386–391 (2003). https://doi.org/10.1007/BF03021037
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DOI: https://doi.org/10.1007/BF03021037