Can Femoral Artery Pressure Monitoring Be Used Routinely in Cardiac Surgery? Fadia Haddad, MD,* Carine Zeeni, MD,* Issam El Rassi, MD,† Alexandre Yazigi, MD,* Samia Madi-Jebara, MD,* Gemma Hayeck, MD,* Victor Jebara, MD,† and Patricia Yazbeck, MD* Objective: The purpose of this study was to evaluate the safety of femoral arterial pressure monitoring in cardiac surgery. Design: Prospective, observational study. Setting: Cardiac surgery unit (CSU) in a university hospital. Participants: Of a total of 2,350 consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass, 2,264 patients with femoral artery pressure moni- toring were included. Interventions: A femoral arterial catheter was inserted percutaneously before the induction of anesthesia. The cath- eter was withdrawn 40 to 96 hours after surgery. It was replaced by a radial artery catheter in patients staying for more than 4 days in the CSU or in case of pulse loss or lower limb ischemia. The catheter was removed and sent for cul- tures whenever it showed local changes, discharge, or if sepsis was suspected. Measurements and Main Results: Pain on insertion ranged from 0 to 20 mm on the 100-mm visual analog scale. Com- plications related to femoral artery cannulation were re- corded. No cases of femoral artery thrombosis, lower ex- tremity ischemia, or hematoma requiring surgery were noted. Small hematomas were observed in 3.3% of patients. The incidence of oozing was 2.1% after the insertion of the catheter and 4.9% after its removal. Three cases (0.13%) of serious bleeding occurred; 2 required surgery. Eight percent of catheter tips were sent for culture, and positive bacterial growth was recorded in 18.6% of them. Catheter-related blood stream infection occurred in 0.5% of the total patient population included. Conclusions: Femoral artery pressure monitoring was as- sociated with a low complication rate and, therefore, it can be used routinely in cardiac surgery. © 2008 Elsevier Inc. All rights reserved. KEY WORDS: intensive care, arterial catheter, femoral artery catheter, arterial catheter complication, arterial pressure gradient, cardiac surgery, radial artery catheter R ADIAL ARTERIAL PRESSURE underestimates aortic pressure during and after cardiopulmonary bypass (CPB). 1-3 This discrepancy has been extensively investigated, and its exact mechanism remains unclear. 1,4-8 The authors think that the pressure gradient can sometimes lead to overtreatment errors in an otherwise normotensive patient. The femoral artery pressure provides an accurate and reliable measurement of the aortic pressure after CPB. 9-12 Despite this, it is the radial and not the femoral artery that is routinely used as a cannulation site for arterial pressure monitoring during cardiac surgery. This is probably because of studies conducted in intensive care units (ICUs) showing a higher complication rate, especially infec- tious, related to femoral artery cannulation compared with radial artery cannulation. 13,14 The authors have been routinely monitoring the femoral arterial pressure in all cardiac surgical patients since 2002, unless specific conditions contraindicate femoral artery cathe- terization. A prospective observational study was performed to evaluate the incidence of complications and the pain intensity related to femoral arterial cannulation in cardiac surgery. The objective was to evaluate the safety of femoral arterial pressure monitor- ing in patients undergoing cardiac surgery with CPB. METHODS Between January 2002 and June 2006, 2,350 patients were scheduled for elective cardiac surgery with CPB. Two thousand two hundred sixty-four patients were included in this prospective study. The exclu- sion criteria for femoral artery catheterization were severe atheroscle- rotic disease of the abdominal aorta, severe iliofemoral arterial steno- ses, peripheral lower limb arterial disease diagnosed before surgery, the possible need of the femoral artery for arterial surgical cannulation or for insertion of an intra-aortic balloon, skin infection or ulceration of the site of puncture, and technical difficulties or failure to catheterize the femoral artery. In these excluded patients, radial or brachial arterial catheters were inserted; they were not considered as a failure group because the study design focused on the complications of successfully inserted femoral arterial catheters. In all patients included in the study, the management of invasive monitoring devices and anesthetic man- agement were performed according to institutional protocols. This study was approved by the local institutional review board, and signed informed consent was obtained preoperatively from all patients. All relevant medical data were recorded by the senior anesthesiologists or the anesthesiology residents. Before the induction of anesthesia, a 5F (16-G) polyurethane, non- coated arterial catheter (Plastimed, Seldicath, France; length: 11 cm for males, 8 cm for females) was inserted percutaneously in the femoral artery under local anesthesia and light sedation. Before puncture, explanation and psychological preparation were performed by the anesthesiologist and 1 to 2 mg of intravenous midazolam was admin- istered with electrocardiographic monitoring, pulse oximetry, and sup- plemental oxygen. Insertion site preparation was conducted following the guidelines for the prevention of intravascular catheter-related in- fections of the Centers for Disease Control and Prevention (CDC). 15 Good hand hygiene was achieved through the use of an antibacterial soap with adequate rinsing, followed by the use of sterile gloves. The skin was prepped with povidone iodine that was allowed to air dry before catheter insertion. Sterile drapes were applied around the groin to isolate the prepped area. The skin and subcutaneous tissues were infiltrated with 6 to 8 mL of 1% lidocaine, using a 22-G needle. The catheter was inserted using Seldinger’s technique and fixed to the skin. Arterial pressure catheters were transduced (Medex Medical Ltd, Haslingden, UK) and connected to a component monitoring system From the Departments of *Anesthesiology and Intensive Care and †Cardiac Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Address reprint requests to Fadia Haddad, MD, Department of Anesthesiology and Intensive Care, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Street, PO Box 166830, Ashrafieh, Beirut, Lebanon. E-mail: fflhlb@yahoo.com © 2008 Elsevier Inc. All rights reserved. 1053-0770/08/2203-0013$34.00/0 doi:10.1053/j.jvca.2007.10.010 418 Journal of Cardiothoracic and Vascular Anesthesia, Vol 22, No 3 (June), 2008: pp 418-422