Peripheral arterial line

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Peripheral arterial line - infants

Alternative Names

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

Information

A peripheral arterial line (PAL) is a tiny, short, flexible catheter that is put through the skin into an artery of the arm or leg. Health care providers sometimes call it an "art line" or "a pal." 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 puncture the skin repeatedly to draw blood from a baby. A PAL is often needed if a baby has:

Severe lung or heart disease and is on a ventilator or other life support (for example, ECMO)
Low blood pressure requiring medicine
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. The PAL is then connected to an IV fluid bag and blood pressure monitor.

WHAT ARE THE RISKS OF A PAL?

Risks include:

The greatest risk is that the PAL can stop 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.

References

Donn SM, Stepanovich GE, Attar MA. Assisted ventilation and its complications. In: Martin RJ, Fanaroff AA, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 66.

Edwards LR, Malone MP, Prodhan P, Schexnayder SM. Pediatric vascular access and centeses. In: Zimmerman JJ, Clark RSB, Fuhrman BP, et al, eds. Fuhrman and Zimmerman's Pediatric Critical Care. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Review Date: 12/31/2023
Reviewed By: Mary J. Terrell, MD, IBCLC, Neonatologist, Cape Fear Valley Medical Center, Fayetteville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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