284
February 1978 TheJournalofPEDIATRICS
Clinical note Warning: Serious sequelae Of temporal artery catheterization
Many techniques, including umlpilical artery catheterization, radial artery catheterization, indwelling percutaneous temporal artery needle puncture, repeated percutaneous arterial r~eedle puncture, and arterialized capillary sampling, have been used to prov!de access to the arterial circulation. Recently, a technique of temporal artery catheterization has been described and widely used on our nursery services. 1 Temporal artery catheterization has been shown to be a relatively easy, rapid, and reliable procedure, but long-term follow-up has not been available. We have recently cared for three infants who developed central nervous system sequelae which suggest that temporal artery catheterization carries serious risks and should be avoided. Each infant had a temporal arterY cutdown because of respiratory distress. One cutdown was placed after failure of an umbilical artery catheterization and two after removal of an umbilical artery catheter. A left temporal artery cutdown was performed in each infant and was in place for at least four days. N o unusual problems with the arterial lines were encountered, and all were constantly infused with a heparin (2 units/ml), glucose, and electrolyte solution. No focal neurologic deficits, seizures, or other neurologic symptoms were apparent during hospitalization or during the first four months of follow-up. Each infant developed, by six months of age, a definite hemiplegia contralateral to the temporal arterial catheter site. A computerized axial tomography study in two infants demonstrated infarction of the cerebral cortex; total infarction in the left middle cerebral artery distribution was seen in one of these infants (Fig. 1). In our follow-up experience, a major hemiplegia is a very rare finding; even among severely handicapped infants. Thus, the association of a hemiplegia contralateral to a temporal artery cutdown in three infants, two without other serious defects, strongly suggests a causal relationship. This is perhaps not surprising, given the high incidence of catheter-related thromboses now recognized with unbilical arterial cathetersP -4 Given the proximity of a temporal artery catheter to the carotid bifurcation, a clot could easily be dislodged from the catheter during irrigation and pass to the internal carotid circulation. It is particularly disturbing that a severe hemiplegia was not detected during hospitalization, or initially during follow-up in any of the infants. Severe neurologic complications, possibly iatrogenic, may appear in these patients after an apparently benign and reassuring period of follow-up. Michael A. Simmons is an Established L~vestigator of the American Heart Association.
Vol. 92, No. 2, p. 284
Fig. 1. Computerized tomography showing total infarction in the left middle cerebral artery distribution. The frequency of such complications after temporal artery catheterization is not yet known, but the severity of these sequelae suggests that temporal artery catheterization should be done only under exceptional circumstances, if at all. Michael A. Simmons, M.D. Rodney L. Levine, M.D. Lula O. Lubchenco, M.D. Mary Anne Guggenheim, M.D. Department o f Pediatrics University of Colorado Medical Center 4200 East Ninth Ave. Denver, CO 80262
REFERENCES 1. Prian G: A new technique for long-term arterial access in the high-risk newborn, Pediat Res 10:431, 1976. 2. Wigger HJ, Bransilver BR, and Blanc WA: Thromboses due to catheterization in infants and children, J PEDIATR 76:1, 1970. 3. Neal WA, Reynolds JW, Jarvis CW, and Williams H J: Umbilical artery catheterization: Demonstration of arterial thrombosis by aortography, Pediatrics 50:61 1972. 4. Goetzman BW, Stadalnik RC, Bogren HG, Blankenship WJ, Ikeda RM, and Thayer J: Thrombotic complications of umbilical artery catheters: A clinical and radiographic study, Pediatrics 56:374, 1975.
0022-3476/78/0292-0284500.10/0 9 1978 T h e C. V. M o s b y Co.
February 1978 TheJournalofPEDIATRICS
Clinical note Warning: Serious sequelae Of temporal artery catheterization
Many techniques, including umlpilical artery catheterization, radial artery catheterization, indwelling percutaneous temporal artery needle puncture, repeated percutaneous arterial r~eedle puncture, and arterialized capillary sampling, have been used to prov!de access to the arterial circulation. Recently, a technique of temporal artery catheterization has been described and widely used on our nursery services. 1 Temporal artery catheterization has been shown to be a relatively easy, rapid, and reliable procedure, but long-term follow-up has not been available. We have recently cared for three infants who developed central nervous system sequelae which suggest that temporal artery catheterization carries serious risks and should be avoided. Each infant had a temporal arterY cutdown because of respiratory distress. One cutdown was placed after failure of an umbilical artery catheterization and two after removal of an umbilical artery catheter. A left temporal artery cutdown was performed in each infant and was in place for at least four days. N o unusual problems with the arterial lines were encountered, and all were constantly infused with a heparin (2 units/ml), glucose, and electrolyte solution. No focal neurologic deficits, seizures, or other neurologic symptoms were apparent during hospitalization or during the first four months of follow-up. Each infant developed, by six months of age, a definite hemiplegia contralateral to the temporal arterial catheter site. A computerized axial tomography study in two infants demonstrated infarction of the cerebral cortex; total infarction in the left middle cerebral artery distribution was seen in one of these infants (Fig. 1). In our follow-up experience, a major hemiplegia is a very rare finding; even among severely handicapped infants. Thus, the association of a hemiplegia contralateral to a temporal artery cutdown in three infants, two without other serious defects, strongly suggests a causal relationship. This is perhaps not surprising, given the high incidence of catheter-related thromboses now recognized with unbilical arterial cathetersP -4 Given the proximity of a temporal artery catheter to the carotid bifurcation, a clot could easily be dislodged from the catheter during irrigation and pass to the internal carotid circulation. It is particularly disturbing that a severe hemiplegia was not detected during hospitalization, or initially during follow-up in any of the infants. Severe neurologic complications, possibly iatrogenic, may appear in these patients after an apparently benign and reassuring period of follow-up. Michael A. Simmons is an Established L~vestigator of the American Heart Association.
Vol. 92, No. 2, p. 284
Fig. 1. Computerized tomography showing total infarction in the left middle cerebral artery distribution. The frequency of such complications after temporal artery catheterization is not yet known, but the severity of these sequelae suggests that temporal artery catheterization should be done only under exceptional circumstances, if at all. Michael A. Simmons, M.D. Rodney L. Levine, M.D. Lula O. Lubchenco, M.D. Mary Anne Guggenheim, M.D. Department o f Pediatrics University of Colorado Medical Center 4200 East Ninth Ave. Denver, CO 80262
REFERENCES 1. Prian G: A new technique for long-term arterial access in the high-risk newborn, Pediat Res 10:431, 1976. 2. Wigger HJ, Bransilver BR, and Blanc WA: Thromboses due to catheterization in infants and children, J PEDIATR 76:1, 1970. 3. Neal WA, Reynolds JW, Jarvis CW, and Williams H J: Umbilical artery catheterization: Demonstration of arterial thrombosis by aortography, Pediatrics 50:61 1972. 4. Goetzman BW, Stadalnik RC, Bogren HG, Blankenship WJ, Ikeda RM, and Thayer J: Thrombotic complications of umbilical artery catheters: A clinical and radiographic study, Pediatrics 56:374, 1975.
0022-3476/78/0292-0284500.10/0 9 1978 T h e C. V. M o s b y Co.
