The use of papaverine in arterial sheaths to prevent loss of femoral artery pulse
in pediatric cardiac catheterization.
Author(s): Boris JR, Harned RK 2nd, Logan LA, Wiggins JW Jr.
Affiliation(s): Department of Pediatric Cardiology, The Children's Hospital, 1056 East 19th
Avenue, Denver, CO 80218, USA.
Publication date & source: 1998, Pediatr Cardiol. , 19(5):390-7
This study evaluated the efficacy of intraarterial papaverine infusion after
pediatric cardiac catheterization in reducing the incidence of lost pulse. This
study was conducted at a teaching pediatric hospital and was designed as a
randomized, prospective, double-blind, placebo-controlled study. Patients were
children 5 years old or less undergoing antegrade and retrograde heart
catheterization. The intervention used was an intraarterial infusion of placebo
or 1.5 mg/kg papaverine after catheterization. Bilateral femoral artery
ultrasound study was performed pre- and postcatheterization, including
two-dimensional, color, spectral, and pulsatility index analysis. Outcome
measures included clinical loss of pulse, ultrasound findings, plus other
clinical factors. Fifty-six patients participated in the study (28 per group).
Six patients clinically lost the pulse in the catheterized arteries [four in the
papaverine and two in the placebo groups (p > 0.64)]. Clinical loss of pulse
correlated with diminished pulsatility index (p < 0.035). The use of papaverine
did not prevent decreased pulse or pulsatility index (p > 0.79). Increased
arterial time was the only clinical factor associated with lost pulse (p <
0.0004). Pulsatility index <3.34 correlated with loss of pulse in the
catheterized artery. The results indicated that intraarterial papaverine infusion
after femoral artery catheterization does not prevent loss of pulse in the
catheterized artery, and decreased pulsatility index correlates with diminished
pulse and represents a good noninvasive method of evaluating femoral artery
patency and flow.
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