Arterial fast bolus flush systems used routinely in neonates and infants cause retrograde embolization of flush solution into the central arterial and cerebral circulation

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Abstract
To evaluate the risk of retrograde embolization of flush solution in neonates and infants with routinely used electronic syringe pumps and infusion bag pump flush systems. With hospital Ethical Committee approval we studied intubated neonates and infants with a 24-GA radial arterial cannula. Fast flush boluses were delivered from the infusion bag pump flush system by opening the flow regulating device for two seconds at bag pump manometre pressures of 100, 200 and 300 mmHg. In the syringe pump flush system, fast flush bolus volumes of 0.5, 1.0, 1.5 and 2.0 mL were programmed on the electronic syringe pump and released by opening the flow regulating device for two seconds. A 12-MHz ultrasonic probe placed in the jugular fossa was used to detect white bubbles indicating retrograde embolization of flush solution into the ipsilateral subclavian and common carotid artery. Sixteen patients, aged from 1-105 days (median 22 days) were studied. In all patients retrograde embolization into the subclavian artery was detected at syringe pump bolus volumes of 0.5-1.5 mL and at 100-200 mmHg bag pump pressure. In nine of the 16 patients a positive signal was detected in the common carotid artery with 1.5-2.0 mL syringe pump bolus volumes and at 200-300 mmHg bag pump pressure. In neonates and infants, the standard practice of arterial fast bolus flushing using syringe pump and bag pump flush systems causes retrograde embolization of flush solution into the central arterial and even into the cerebral circulation. The mandatory limitation of fast flush bolus volumes and manometre pressures is urgent in order to reduce retrograde embolization of flush solution and the associated risks in these small patients.