Safety and Sustainability of Axillary Versus Radial Arterial Catheters in Critically Ill Children: A Retrospective Comparative Study

ABSTRACT Background Arterial catheters are commonly used for hemodynamic monitoring and blood sampling in critically ill children, with the radial artery being the typical site. When radial cannulation is not feasible, alternative sites like the axillary artery may be utilized. However, the safety and sustainability of axillary arterial catheters compared to radial catheters in this population remain unclear. Aims This study aims to assess the safety and sustainability of axillary arterial catheters compared to radial arterial catheters in pediatric intensive care unit patients. Methods We conducted a retrospective, case–control study at a university‐affiliated tertiary care pediatric intensive care unit. Patients aged 18 years or younger with axillary arterial catheters from January 2007 to December 2023 were compared to patients of similar ages with radial catheters. Results A computerized chart review identified 306 patients with axillary catheters, compared to 306 randomly selected patients with radial catheters. The rate of catheter site replacement was identical in both groups (40 out of 306). The median duration of axillary catheter use was 34 h longer (95% CI: 24–48; p < 0.001). Only one patient in the axillary group (0.33%) experienced a vascular complication, recovering fully after intervention. Patients with axillary catheters were characterized by a higher Pediatric Index of Mortality 3 scores, Vasoactive‐Inotropic Scores, and PICU mortality rates. Conclusions In this critically ill pediatric cohort, axillary arterial catheters were used longer and in a more severely ill population than radial catheters. Despite these differences, both catheter types demonstrated comparable safety and sustainability profiles.