Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients.
In critical care settings, arterial catheters (ACs) are very useful in monitoring the blood pressure and are often used for repetitive blood sampling. No studies have been performed that compare the approach and complication rates of ACs in a medical intensive care unit (MICU) to those in a surgical intensive care unit (SICU). Over a 24-month period, 3255 patients were admitted to the MICU and 1677 to the SICU of Howard University Hospital. Of the total patients admitted, 2119 patients had an AC placed at the time of admission and were included in this study. Patient age, site of catheter insertion, interval to catheter change, number of changes, and overall complications associated with arterial catheterization were determined for both ICUs. In the MICU, 1554 patients (48%) were subjected to an AC as compared to 565 (33%) in the SICU. The femoral artery was cannulated in 45 per cent of the patients in the MICU and in 11.5 per cent in the SICU. The radial artery was used in 52 per cent of MICU patients and in 78 per cent of SICU patients. The brachial artery was cannulated in 0.5 per cent of MICU patients and 3 per cent of SICU patients. AC was changed in 9.5 per cent of MICU patients and 13 per cent of SICU patients. The choice of the femoral artery as a new line was more common in the MICU than in the SICU. The most common complication was vascular insufficiency (3.4% in MICU and 4.6% in SICU), followed by bleeding (1.8% in MICU and 2.6% in SICU) and infection (0.4% in MICU and 0.7% in SICU). Patients who had femoral arterial lines in MICU were older than those in SICU (mean age, 66 vs 43 years). Rate of infection was similar in both ICUs and between radial and femoral arterial sites (43% in MICU and 50% in SICU). We conclude that the preferred site for artificial cannulation in MICU is femoral and in SICU is radial artery. The infection rate was similar in both units, regardless of the different site or approach used. Vascular insufficiency followed by bleeding was the most common vascular complication after line changes using a guide wire. Arterial spasm and pulselessness were more commonly found after new-site insertion. The site of AC placement and the timing/number of catheter/site changes made no significant difference in terms of complications, which is a new finding compared to other previous reports. The rates of infection between radial and femoral artery were similar.
Frezza
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Department of Surgery, Howard University Hospital, Washington, DC, USA.
Mezghebe
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D000328:Adult; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data; D003422:Critical Care; D005263:Femoral Artery; D006801:Humans; D007362:Intensive Care Units; D017534:Radial Artery; D012189:Retrospective Studies