ICU and Inpatient Clinical Pathway
for Children with Post-Cath Pulse Loss
Infants and children with absent or markedly diminished pulse at 1 hr post-cardiac catheterization
- Cool, pale, markedly delayed or absent cap refill
- Ischemic Limb Management
- Initiate enoxaparin
- Use heparin as alternative as indicated
- US Doppler Lower Extremity ART—Aorta to foot
- Review labs, including CBC, BMP, PT/PTT
- Notify cath attending
No thrombus and Normal pulse at 24 hrs
Thrombus present on ultrasound
Continue enoxaparin
Consult cardiac thrombosis serviceDiminished pulse at 24 hrs
Normal pulse at 24 hrs
Repeat femoral artery US
Persistent thrombus
Resolved Thrombus
Clinical Exam
- Good cap refill, color, and temperature
- Continue enoxaparin, therapeutic anti-Xa after 2nd dose
- Discharge teaching completed
- Schedule femoral artery US at 2 wks from date of thrombus
- Cool, pale, markedly delayed or absent cap refill
Discontinue enoxaparin
Resolved thrombus at 2 wks
Persistent thrombus at 2 wks
- Continue enoxaparin
- Monitor femoral ultrasound at 6 and 12 wks from date of thrombus as indicated
Persistent thrombus at 12 wks
Discontinue anticoagulation
Resume antiplatelet treatment per individual regimenStop anticoagulation
Refer to vascular surgery