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Peripheral arterial line - infants

A peripheral arterial line (PAL) is a small, short, plastic catheter that is put through the skin into an artery of the arm or leg. Health care providers sometimes call it an "art line." This article addresses PALs in babies.

WHY IS A PAL USED?

Providers use a PAL to watch your baby's blood pressure. A PAL can also be used to take frequent blood samples, rather than having to draw blood from a baby repeatedly. A PAL is often needed if a baby has:

  • Severe lung disease and is on a ventilator
  • Blood pressure problems and is on medicines for it
  • Prolonged illness or immaturity requiring frequent blood tests

HOW IS A PAL PLACED?

First, the provider cleans the baby's skin with a germ-killing medicine (antiseptic). Then the small catheter is put into the artery. After the PAL is in, it is connected to an IV fluid bag and blood pressure monitor.

WHAT ARE THE RISKS OF A PAL?

Risks include:

  • The greatest risk is if the PAL stops blood from going to the hand or foot. Testing before the PAL is placed can prevent this complication in most cases. The NICU nurses will carefully watch your baby for this problem.
  • PALs have a greater risk for bleeding than standard IVs.
  • There is a small risk for infection, but it is lower than the risk from a standard IV.

Alternative Names

PAL - infants; Art line - infants; Arterial line - neonatal

References

Centers for Disease Control and Prevention website. 2017 Recommendations on use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections: an update to the 2011 guidelines for the prevention of intravascular catheter-related infections from the Centers for Disease Control and Prevention. www.cdc.gov/infectioncontrol/guidelines/pdf/bsi/c-i-dressings-H.pdf. Updated July 17, 2017. Accessed January 29, 2018.

Crowley MA, Stork EK. Therapy for cardiorespiratory failure in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 78.

Pasala S, Storm EA, Stroud MH, et al. Pediatric vascular access and centeses. In: Fuhrman BP, Zimmerman JJ, eds. Pediatric Critical Care. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 19.

Santillanes G, Claudius I. Pediatric vascular access and blood sampling techniques. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 19.

Review Date 12/13/2017

Updated by: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.