Can femoral artery pressure monitoring be used routinely in cardiac surgery?

摘要

OBJECTIVE: The purpose of this study was to evaluate the safety of femoral arterial pressure monitoring in cardiac surgery. DESIGN: Prospective, observational study. SETTING: Cardiac surgery unit (CSU) in a university hospital. PARTICIPANTS: Of a total of 2,350 consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass, 2,264 patients with femoral artery pressure monitoring were included. INTERVENTIONS: A femoral arterial catheter was inserted percutaneously before the induction of anesthesia. The catheter was withdrawn 40 to 96 hours after surgery. It was replaced by a radial artery catheter in patients staying for more than 4 days in the CSU or in case of pulse loss or lower limb ischemia. The catheter was removed and sent for cultures whenever it showed local changes, discharge, or if sepsis was suspected. MEASUREMENTS AND MAIN RESULTS: Pain on insertion ranged from 0 to 20 mm on the 100-mm visual analog scale. Complications related to femoral artery cannulation were recorded. No cases of femoral artery thrombosis, lower extremity ischemia, or hematoma requiring surgery were noted. Small hematomas were observed in 3.3% of patients. The incidence of oozing was 2.1% after the insertion of the catheter and 4.9% after its removal. Three cases (0.13%) of serious bleeding occurred; 2 required surgery. Eight percent of catheter tips were sent for culture, and positive bacterial growth was recorded in 18.6% of them. Catheter-related blood stream infection occurred in 0.5% of the total patient population included. CONCLUSIONS: Femoral artery pressure monitoring was associated with a low complication rate and, therefore, it can be used routinely in cardiac surgery.