I think we must use all the time sterile gloves for this procedure. In the same time with sterile or non sterile gloves don't change the sensibility for arterial catheterization. About catheterization of artery without gloves I'm not sure to be a good idea.

To Mr. Savan Veaceslav. Thank you for your valuable comment especially in the sensibility.

I totally agree with you, in sick neonates it could be difficult to place an arterial catheter with gloves and gloves do change the sensibility.

The most important is a "surgical" handswashing and skin disinfection. In fact for arterial catheterization you never touch the catheter that will be introduced in the artery, but only the tip. Once the catheter is in the artery, you use gloves for handling of the guide wire and insertion of dilator. 

For "long term" venous perfusion in neonates, venous Cathlon catheter are inserted  without gloves and without related infection. For "short term" arterial catheterization  why should it be different?

To Dr. Yves Durandy, I appreciate your helpful comment. Some famous Japanese pediatric anesthesiologists and Dr. Veaceslav Savan strongly advocate using sterile gloves for arterial catheterization. Even without sterile gloves, it sometime takes a lot of time to secure arterial lines especially in neonates and infants with left to right intracardiac shunting and congestive heart failure. I think I have to wear sterile gloves; however, I cannot strongly insist on securing arterial line with gloves. As you suggested, we should carry out surgical handswashing and skin disinfection strictly.

To Dr. Kenji Kayashima. I understand that you speak on arterial catheterization for monitoring of blood pressure. I totally agree with you, it is challenging and useless to secure an arterial line on a neonate with sterile gloves. The major issue is: Is there any data demonstrating systemic or local infection following insertion of arterial lines without sterile gloves? The second issue is: if we use gloves do we increase the risk of arterial dissection or hematoma or even failure to catheterize the artery?

What is the rationale to put sterile gloves and then touch non sterile areas like the skin of the neonate?

Many hygienic standard are intuitive but were never demonstrated. 

Thank you again for your comment, Dr. Yves Durandy.

First, I do not think there are any data demonstrating systemic or local infection following insertion of arterial lines without sterile gloves. Second, I have never seen the data about using gloves to increase the risk of arterial dissection or hematoma or even failure to catheterize the artery.

It seems difficult to get appropriate articles regarding pediatric artery infection or damage. I can show only a few articles regarding infection as below.

Furfaro S, et al. Arterial catheter-related infections in children. A 1-year cohort analysis. Am J Dis Child. 1991 Sep;145(9):1037-43. To determine the incidence of infection secondary to arterial catheterization in children as well as the risk markers, they prospectively evaluated, during a 1-year period, all arterial catheters installed in children admitted to the pediatric intensive care unit. The results confirm the very low incidence of infection related to arterial catheterization in children. 

Koh DB, et al. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Crit Care Med. 2008 Feb;36(2):397-402. Three hundred twenty-one arterial catheters in 252 adult and pediatric patients were observed for 1,082 catheter days, and 618 central venous catheters in 410 patients were observed for 4,040 catheter days. The incidence per 1,000 catheter days of colonization and catheter-related bloodstream infection was 15.7 and 0.92 for arterial catheters and 16.8 and 2.23 for central venous catheters. Arterial catheter colonization was not significantly different than that in central venous catheters (hazard ratio, 1.17; 95% confidence interval, 0.41-3.36; p = .77). The incidence of catheter-related bloodstream infection from arterial catheters was low.

Lorente L, et al. Arterial catheter-related infection of 2,949 catheters. Crit Care. 2006;10(3):R83. The CRBSI incidence was significantly higher for femoral access (1.92/1,000 catheter-days) than for radial access (0.25/1,000 catheter-days).

Dr  Kenji Kayashima,

Thank you for your answer. It is true that literature on the topic is not abundant. Furthermore the complications related to insertion of an arterial catheter depends mainly on the experience of the medical staff. I work in pediatric cardiac surgery and arterial catheterization is a routine procedure for neonates. Obviously there is a learning curve for any anesthetist, intensivist, and nurse involved in neonatal arterial catheterization.

If you look at protocols used for arterial catheter insertion you will find that there is no consensus. For example in the Great Ormond Street Hospital protocol (www.gosh.nhs.uk)  non-sterile gloves are used for arterial catheter insertion.

About infection a recent publication is the meta analysis from O'horo Crit Care Med 2014; 42 (6): 1334-9.However, the definition of catheter related bloodstream infection is classical but highly questionable.

Catheter-related bloodstream infection was defined as positive blood culture collected from an arterial catheter and from the periphery with the same organism in a patient demonstrating systemic sign of sepsis.

This is sometime unrealistic in neonates with limited peripheral access and does that mean that an arterial catheter cannot be colonized by a bloodstream infection?

To Dr. Yves Durandy. Thank you again. I will check your information, the Great Ormond Street Hospital protocol (www.gosh.nhs.uk) including non-sterile gloves for arterial catheter insertion and the recent publication, the meta analysis from O'horo Crit Care Med 2014; 42 (6): 1334-9.