Abstract
Acute femoral artery occlusion is common in pediatric patients following cardiac catheterization. A variety of means are utilized to assess lower extremity (LE) perfusion and arterial patency following cardiac catheterization including palpation of pulses, pulse oximetry, subjective assessment of lower extremity color and temperature, and ultrasound. We sought to evaluate the utility of Near-Infrared Spectroscopy (NIRS) to monitor LE perfusion in pediatric patients undergoing cardiac catheterization. INVOS pediatric sensors were placed on bilateral LE in all pediatric patients ≤ 40 kg undergoing cardiac catheterization. Data were recorded continuously from the start of the procedure until 4–6 h after completion of the procedure. NIRS readings were compared between the accessed versus non-accessed LE at baseline before start of case, time of vascular access, arterial sheath exchange when applicable, sheath withdrawal, and Safeguard application, deflation, and removal. 133 patients underwent 152 catheterizations with mean age 2.4 ± 2.3 years and mean weight 12.4 ± 13.2 kg. NIRS oximetry readings were significantly decreased in the LE with arterial access compared to non-accessed LE from time of sheath insertion until removal of the pressure assist device post procedure. A greater difference was noted in smaller patients. NIRS oximetry readings did not correlate with subjective assessment of lower extremity perfusion after arterial sheaths were removed. One patient had pulse loss 4 h post procedure with a decrease in oximetry readings noted at this point on review. Weight-based heparin protocol was initiated, and a gradual improvement in oximetry readings was noted over the next 5 h. Vascular ultrasound 12 h later showed no evidence of arterial thrombus. NIRS may be helpful in identifying patients who are risk for developing arterial thrombus post cardiac catheterization and for monitoring response to therapy; however, further study in these patients is warranted.
Similar content being viewed by others
References
Glatz AC, Keashen R, Chang J, Balsama L, Dori Y, Gillespie MJ, Gigilia TM, Raffini L, Rome JJ (2015) Outcomes using a clinical practice pathway for the management of pulse loss following pediatric cardiac catheterization. Catheter Cardiovasc Interv 85:111–117
Glatz AC, Shah SS, McCarthy AL, Geisser D, Kaitlyn D, Dawei X, Hanna BD, Grundmeier RW, Gillespie MJ, Rome JJ (2013) Prevalance of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study. Catheter Cardiovasc Interv 82:454–462
Bergersen L, Marshall A, Gauvreau K, Beekman R, Hirsch R, Foerster S, Balzer D, Vincent J, Hellenbrand W, Holzer R, Cheatham J, Moore J, Lock J, Jenkins K (2010) Adverse event rates in congenital cardiac catheterization—a multi-center experience. Catheter Cardiovasc Interv 75:389–400
Roushdy AM, Abdelmonem N, El Fiky AA (2012) Factors affecting vascular access complications in children undergoing congenital cardiac catheterization. Cardiol Young 22:136–144
Alexander J, Yohannan T, Abutineh I, Agrawal V, Lloyd H, Zurakowski D, Waller BR, Sathanandam S (2016) Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: a prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse. Catheter Cardiovasc Interv 88:1098–1107
Schachner T, Bonaros N, Bonatti J, Kolbitsch C (2008) Near infrared spectroscopy for controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass. Eur J Cardiothorac Surg 34(6):1253–1254
Vida VL, Padalino MA, Boccuzzo G, Stellin G (2012) Near-infrared sepectroscopy for monitoring leg perfusion during minimally invasive surgery for patients with congenital heart defects. J Thorac Cardiovasc Surg 143:756–757
Prkic I, Stuth EA (2016) Near-infrared spectroscopy provides continuous monitoring of compromised lower extremity perfusion during cardiac surgery. J Clin Anesthesiol 31:38–41
Tobias JD, Hoernschemeyer DG (2007) Near-infrared spectroscopy identifies compartment syndrome in an infant. J Pediatr Orthop 27(3):311–313
Shadgan B, Menon M, Sanders D, Berry G, Martin C, Duffy P, Stephen D, O’Brien PJ (2010) Current thinking about acute compartment syndrome of the lower extremity. Can J Surg 53(5):329–334
Bonaros N, Wiedemann D, Nagiller J, Feuchtner G, Kolbitsch C, Kaufmann M, Bonatti J, Schachner T (2009) Distal leg protection for periphberal cannulation in minimally invasive and totally endoscopic cardiac surgery. Heart Surgery Forum 12(3):E158–E162
Lin PH, Dodson TF, Bush RL et al (2001) Surgical intervention for complications caused by femoral artery catheterization in pediatric patients. J Vasc Surg 72:278–285
Frezza EE, Mezghebe H (1998) Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients. Am Surg 64:127–131
Mortensson W (1976) Agniography of the femoral artery following percuteneous catheterization in infants and children. Acta Radiol Diagn 17:581–593
Williams EC (1990) Catheter-related thrombus. Clin Cardiol 13:V134–V136
Jobias FF (1977) Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 198(4323):164–167
Moerman A, Meert F, De Hert S (2016) Cerebral near-infrared spectroscopy in the care of patients during cardiological procedures: a summary of the clinical evidence. J Clin Monit Coput 30(6):901–909
Tanidir IC, Ozturk E, Ozyilmaz I, Saygi M, Kiplapinar N, Haydin S, Guzeltas A, Odemis E (2014) Near infrared spectroscopy monitoring in the pediatric cardiac catheterization laboratory. Artif Organs 38(10):838–844
Kamyszek RW, Leraas HJ, Nag UP et al (2019) Routine postprocedure ultrasound increases the rate of detection of femoral arterial thrombosis in infants after cardiac catheterization. Catheter Cardiovasc Interv 93:652–659
Funding
Pediatric Sensors donated for use in this study by Covidien Inc.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Herbert, C.E., Leshko, J., Morelli, D. et al. Use of Near-Infrared Spectroscopy to Monitor Lower Extremity Perfusion in Pediatric Patients Undergoing Cardiac Catheterization. Pediatr Cardiol 40, 1523–1529 (2019). https://doi.org/10.1007/s00246-019-02179-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-019-02179-z