Vol.:(0123456789) 1 3 Pediatric Cardiology https://doi.org/10.1007/s00246-019-02179-z ORIGINAL ARTICLE Use of Near‑Infrared Spectroscopy to Monitor Lower Extremity Perfusion in Pediatric Patients Undergoing Cardiac Catheterization Carrie E. Herbert 1  · Jenny Leshko 1  · Dawn Morelli 1  · Ernest Amankwah 1  · Jade Hanson 1  · Gary E. Stapleton 1,2 Received: 17 October 2018 / Accepted: 29 July 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Acute femoral artery occlusion is common in pediatric patients following cardiac catheterization. A variety of means are utilized to assess lower extremity (LE) perfusion and arterial patency following cardiac catheterization including palpation of pulses, pulse oximetry, subjective assessment of lower extremity color and temperature, and ultrasound. We sought to evaluate the utility of Near-Infrared Spectroscopy (NIRS) to monitor LE perfusion in pediatric patients undergoing cardiac catheterization. INVOS pediatric sensors were placed on bilateral LE in all pediatric patients ≤ 40 kg undergoing cardiac catheterization. Data were recorded continuously from the start of the procedure until 4–6 h after completion of the pro- cedure. NIRS readings were compared between the accessed versus non-accessed LE at baseline before start of case, time of vascular access, arterial sheath exchange when applicable, sheath withdrawal, and Safeguard application, defation, and removal. 133 patients underwent 152 catheterizations with mean age 2.4 ± 2.3 years and mean weight 12.4 ± 13.2 kg. NIRS oximetry readings were signifcantly decreased in the LE with arterial access compared to non-accessed LE from time of sheath insertion until removal of the pressure assist device post procedure. A greater diference was noted in smaller patients. NIRS oximetry readings did not correlate with subjective assessment of lower extremity perfusion after arterial sheaths were removed. One patient had pulse loss 4 h post procedure with a decrease in oximetry readings noted at this point on review. Weight-based heparin protocol was initiated, and a gradual improvement in oximetry readings was noted over the next 5 h. Vascular ultrasound 12 h later showed no evidence of arterial thrombus. NIRS may be helpful in identifying patients who are risk for developing arterial thrombus post cardiac catheterization and for monitoring response to therapy; however, further study in these patients is warranted. Keywords Near-Infrared Spectroscopy · Cardiac catheterization · Pediatric · Lower extremity Introduction Acute femoral artery occlusion following cardiac catheteri- zation is common in pediatric patients with a reported inci- dence of 1–9% in more contemporary studies [1–5]. Treat- ment with weight-based heparin or enoxaparin is utilized in patients with suspected or known acute thrombus formation with pulse loss or diminished lower extremity perfusion. A variety of diferent means are utilized to assess lower extremity perfusion and arterial patency following cardiac catheterization including palpation of distal lower extremity pulses, pulse oximetry, and subjective assessment of extrem- ity color and tactile temperature. However, these are inter- mittent monitoring tools which are subjective to provider variability and may create missed opportunities to identify arterial occlusion in the post catheterization period. Ultra- sound may also be used to look for femoral artery thrombus formation; however, this is often utilized after subjective assessment of lower extremity perfusion. Near-Infrared Spectroscopy (NIRS) has been used exten- sively in post-operative management of pediatric patients with complex congenital heart disease, predominantly to evaluate cerebral and abdominal mesenteric regional perfu- sion. More recently there have been reports of using NIRS to monitor lower extremity perfusion following lower extremity trauma or femoral artery cannulation for cardiopulmonary bypass [6–11]. The purpose of this study was to evaluate * Gary E. Stapleton gstapleton68@gmail.com 1 Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, USA 2 Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street Suite 1920, Houston, TX 77025, USA