Peripheral Arterial Lines in Extremely Preterm Neonates: A Potential Alternative to Umbilical Arterial Catheters

Adv Neonatal Care. 2022 Aug 1;22(4):357-361. doi: 10.1097/ANC.0000000000000909. Epub 2021 Jul 30.


Background: Arterial catheterization is a routine procedure in extremely preterm neonates. Umbilical arterial catheters (UACs) are typically used for this purpose, but life-threatening complications have been described. Peripheral arterial lines (PALs) might offer a valuable alternative, but their feasibility in extremely preterm newborns is unclear.

Purpose: To investigate efficacy and complications of PALs in extremely preterm neonates.

Methods: Retrospective analysis of patients born below 26 weeks of gestation in 2011-2014 (cohort 1, UAC as primary arterial access) and 2015-2019 (cohort 2, PAL as primary arterial access). Arterial line placement during their first 14 days of life, duration of arterial access, reasons for discontinuation, and long-term complications were recorded from health records.

Results: In total, 161 of 202 newborns had an arterial line during their first 14 days of life. In cohort 2, the life span of a PAL was significantly longer than that in cohort 1. Signs of dysfunction were the primary reason to discontinue a PAL. Signs of peripheral ischemia were present in 36 of 105 cases (34%) when the PAL was removed but persisted in only 2 patients. UAC-associated persistent ischemic damage occurred in 2 of 97 patients.

Implications for practice and research: PALs are a valuable alternative to UACs even in preterm newborns below 26 weeks of gestational age. A special focus on ischemic complications is warranted. Prospective, multicenter studies to verify safety and efficacy of arterial line management and complications in extremely preterm infants are warranted.

MeSH terms

  • Catheterization, Peripheral* / adverse effects
  • Catheterization, Peripheral* / methods
  • Humans
  • Infant
  • Infant, Extremely Premature
  • Infant, Newborn
  • Prospective Studies
  • Retrospective Studies
  • Umbilical Arteries
  • Vascular Access Devices*