Surveys
2014
February
P
PEDIATRIC ARTERIAL LINE SURVEY

PEDIATRIC ARTERIAL LINE SURVEY

1. Dear colleague,
You are invited to participate in our survey “Pediatric Arterial Line Survey” , promoted by the Department of Anesthesia of the Montreal Children’s Hospital. It will take 10 to 15 minutes to complete this questionnaire. The aim of this survey is to describe the clinical and technical approach to arterial cannulation among pediatric anesthesiologists of Canada, United States, Great Britain and Italy. It is very important for us to learn from your opinions.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. You can also skip most of the questions if you do not want to answer; only a few of them are mandatory (marked with an “*”).

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate, they will be coded and will remain confidential. No personal information will be asked. Data will be stored in a password secured database at the Montreal Children’s Hospital for 5 years. Aggregate results will be circulated to all participants upon completion of the study.
If you have any questions about the survey you may contact Dr. Gianluca Bertolizio at 1-514-413-4400 ext 22464. Or by email at [email protected].

Thank you very much for your time and support. After checking the box below, please start with the survey by clicking on the "Continue" button below.

By checking the box, I agree to participate to the survey

2. What is your current position?

Staff

Fellow

Resident

Other (please specify)

3. In what kind of institution do you work most of the time?

Pediatric University Hospital

University Hospital Mixed Activity (i.e., pediatric and adult activity)

General Hospital Mixed Activity (i.e., pediatric and adult activity)

Private Clinic

Other (please specify)

4. Please provide the Province/State of your medical activity?

5. How often do you practice pediatric anesthesia in the Operating Room per month?

< 4 days per month (one day per week)

4-8 days per month (two days per week)

8-12 days per month (three days per week)

12-16 days per month (four days per week)

> 16 days per month (everyday practice)

6. How many years of experience do you have in pediatric anesthesia?

0-5

6-10

11-15

16-20

> 20

* 7. How often do you place arterial lines in children?

Never

Very occasionally (1-5 per year)

Less than one per month (6-12 per year)

Between one and two per month (13-24 per year)

More than two per month but less than one per working day (25-42 per year)

More than one per week (more than 42 per year)

8. Do you have local written guidelines for arterial cannulation (i.e., technique, dressing, sterile precaution)?

yes (if possible, please specify)

9. What medical device do you usually prefer for arterial cannulation in pediatric patients?

Venous cannula (i.e., Jelco, etc.)

Specific arterial cannula (please specify)

10. How often do you use the following sites as first choice for arterial cannulation?
(5 stars = most of the time; 1 star = least of the time)

Ask/perform a cut-down (any site)

Axillar

Brachial

Dorsalis pedis

Femoral

Radial

Tibialis posterior

Umbilical artery (when appropriate)

Ulnar

11. Assuming that you need to put an arterial line in a full term 1 month old baby with all arterial sites equally available (no specific concerns related to surgery or patient's disease), please mark your preferred sites of cannulation (up to five):

	First choice	Second choice	Third Choice	Fourth choice	Fifth choice	N/A
Ask/perform a cut-down (any site)

Axillar

Brachial

Dorsalis pedis

Femoral

Radial

Tibialis posterior

Ulnar

* 12. In case you put a radial arterial line in a full term 1 month baby, what size would you choose?

26 Gauge iv catheter (i.e., Jelco, etc.)

24 Gauge iv catheter (i.e., Jelco, etc.)

22 Gauge iv catheter (i.e., Jelco, etc.)

Specific arterial cannula (please specify)

* 13. In case you put a femoral arterial line in a full term 1 month baby, what size of catheter would you use?

24 Gauge iv catheter (i.e., Jelco, etc.)

22 Gauge iv catheter (i.e., Jelco, etc.)

2.5 Fr 5 cm

2.5 Fr 8 cm

3 Fr 5 cm

4 Fr 8 cm

Other (please specify)

14. When you decide to change site because unsuccessful at the primary site (arterial supply not compromised after cannulation attempts), what do you do?
(please drag by decreasing level of preference: TOP = first/best choice - BOTTOM = last choice):

	Drag your choices here to rank them
Staying at the same level, same limb (i.e., radial vs ulnar or posterior tibial vs dorsalis pedis) Changing level, same limb (i.e., radial vs brachial or axillar) Changing to controlateral limb (any site) Changin from upper limb to lower (or vice-versa) Prepare for cut down (any site)

15. In cooperative patients and prior to arterial puncturing at radial/ulnar level, do you assess collateral perfusion (most of the time)?

Classical Allen's test (clenching the hand, THEN digital compression of both ulnar and radial arteries, THEN opening the hand and release the pressure on ulnar artery, measure the reperfusion time)

Modified Allen's test (digital compression of both ulnar and radial arteries, THEN clenching and opening the hand, THEN release the pressure on ulnar artery followed by the radial artery, measure the reperfusion time)

Enhanced modified Allen's test (i.e., acoustic and/or color Doppler to evaluate reperfusion adequacy, plethysmography, saturometer during classic Allen's test)

No testing

Other (please specifiy)

16. What technique do you use most of the time to cannulate the artery in an infant (percutaneous approach)?

"Going through the posterior wall and draw back until backflow of blood is seen", then thread OVER a wire (Seldinger technique)

"Going through the posterior wall and draw back until backflow of blood is seen", then thread WITHOUT a wire

" Puncturing and threading the cannula (without hitting the posterior wall)" OVER a wire (Seldinger technique)

" Puncturing and threading the cannula (without hitting the posterior wall)" WITHOUT a wire

I do not use a specific technique

Other (please specify)

* 17. To locate the artery, what technique do you use most of the time?

Anatomical landmarks and/or palpation

Doppler Ultrasound (acoustic signal) before the puncture (pre-procedural scan only)

Puncture assisted with Doppler Ultrasound (changes in acoustic signal during arterial puncturing; real time scan)

2D Ultrasound (anatomy displayed on screen in 2 dimensions) before the puncture (pre-procedural scan only)

Puncture assisted with 2D Ultrasound (visual real time needle tracking, in plane or out of plane)

Other (please specify)

* 18. How often do you use Doppler Ultrasound (acoustic signal) to assist arterial line placement?

Most of the time

Never

Occasionally

19. You use Doppler (acoustic signal) "Most of the time" for arterial cannulation in children because:
(multiple answers possible)

It is superior to other techniques to detect anatomical variations

Teaching interest

The learning curve is faster than with other techniques

I have a higher success rate to cannulate the artery than with other techniques

I need less time to cannulate the artery than with other techniques

Other (please specifiy)

20. You "Never" use Doppler (acoustic signal) for arterial cannulation in children because:
(multiple answers possible)

I do not have the appropriate experience/training to use Doppler for arterial line placement

I do not have access to Doppler in our department

In my clinical practice Doppler for arterial line placement does not offers any advantages over other techniques

Other (please specify)

21. You "Occasionally" use Doppler (acoustic signal) for arterial cannulation in children because:
(multiple answers possible)

I use it as a rescue technique in case of failure with other techniques

I use it when I don't palpate the pulse or recognize landmarks

It decreases the number of subsequent attempts of cannulation

I use it as a teaching tool to locate the artery

Other (please specifiy)

* 22. How often do you use 2D (2 Dimensions) Ultrasound to assist arterial line placement?

Most of the time

Never

Occasionally

23. You use 2D Ultrasound "Most of the time" for arterial cannulation in children because:
(multiple answers possible)

It is superior to other techniques to detect anatomical variations

Teaching interest

The learning curve is faster than with other techniques

I have a higher success rate to cannulate the artery than with other techniques

I need less time to cannulate the artery than with other techniques

I use it to measure the diameter of the artery to choose which catheter size to insert

Other (please specify)

24. You "Never" use 2D Ultrasound for arterial cannulation in children because:
(multiple answers possible)

I do not have the appropriate experience/training to use 2D Ultrasound for arterial line placement

I do not have access to the 2D Ultrasound in our department

In my clinical practice 2D Ultrasound for arterial line placement does not offers any advantages over other techniques

Other (please specify)

25. You "Occasionally" use 2D Ultrasound for arterial cannulation in children because:
(multiple answers possible)

I use it as a rescue technique in case of failure with other techniques

I use it when I don't palpate the pulse or recognize landmarks

It decreases the number of subsequent attempts of cannulation

I use it as a teaching tool to locate the artery

Other (please specify)

26. In the past two years, did you experienced complications related to arterial line cannulation from the time of its placement to its removal?

Yes

I prefer not answering

27. What type of complications related to arterial line cannulation did you experience (multiple answers possible)?

Hematoma

Localised Infection

Nerve injury

Permanent occlusion (severe ischemic damage)

Temporary occlusion (blanching)

Thrombosis / Embolism

None

Other (please specify)

28. What would you usually do in case of blanching of the extremity just after an uneventful cannulation? (multiple answers possible)

Administer a bolus of heparin (please specify the amount of units under "other")

Administer a small dose of lidocaine to resolve the most likely vasospasm

Administer a small dose of papaverine to resolve the most likely vasospasm

Increase the rate/amount of heparin in the pump

Remove the cannula immediately

Wait and monitor the extremity with O2 saturation (look for arterial wave and saturation)

Warm the extremity

Other (please specify)

29. What solution and/or concentration of heparin do you use to keep patent the arterial line (KVO) in children <10 Kg?

Normal Saline

Heparin < 1 UI/ml

Heparin 1 UI/ml

Heparin 2 UI/ml

Heparin > 2 UI/ml

Other (please specify)

30. Please indicate the minimal rate of infusion you run to keep the arterial line patent (ml/h) in children <10 Kg

0.5 ml/h

1 ml/h

2 ml/h

> 2 ml/h

Other (please specify)

31. Thank you for taking part to this survey. Do you have any comments/suggestions regarding it?

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