Brachial artery catheterization: an assessment of use patterns and associated complications.
BACKGROUND
Although studies have compared safety and outcomes of radial artery cannulation with other arterial catheterization locations, there is insufficient information describing brachial artery catheterization. In this study, we characterized the perioperative use patterns and the complication rates associated with brachial arterial catheterization and compared these outcomes with radial artery catheterization.


METHODS
We performed a retrospective analysis of adult patients (age ≥18 years) undergoing surgical procedures at an academic medical center from January 1, 2008, to December 31, 2011. An institutional database containing information on anesthetic care was queried to identify all brachial artery catheterizations. Baseline characteristics, details relating to the surgical and catheterization procedures, and catheter-related complications were collected and compared with a random sample of patients receiving radial artery catheterization.


RESULTS
We identified 858 patients receiving brachial catheterization perioperatively. An additional 3432 patients receiving radial catheterization were identified. Patients receiving brachial catheterization were more often women, had a lower body mass index, had more comorbidities, and had longer anesthetic and catheterization durations. Three vascular complications were identified in the cohort receiving brachial artery catheterization compared with 1 patient with a peripheral neuropathy in the radial artery catheterization cohort (unadjusted complication incidence [95% confidence intervals] brachial artery catheterization, 0.35% [0.12%-1.02%] vs radial artery catheterization, 0.03% [0.005%-0.16%], respectively; P = 0.030; relative risk [95% confidence interval] = 12.0 [1.7-83.4]). There were no catheter-related bloodstream infections.


CONCLUSIONS
We found that brachial artery catheterization is used in more medically complex patients and for longer duration than radial artery catheterizations. Although the limited number of adverse outcomes precluded statistical adjustments in this investigation, the observed differences in complication rates between cannulation methods suggest that brachial artery catheterization may be a suitable alternative to radial artery catheterization in patients with complex medical comorbidities.
From the Department of Anesthesiology, Mayo Clinic College of Medicine; and Department of Anesthesiology and The Perioperative Outcomes, INformatics, and Transfusion (POINT) Study Team, Mayo Clinic, Rochester, Minnesota.
Kathryn S
KS
Handlogten
Gregory A
GA
Wilson
Leanne
L
Clifford
Gregory A
GA
Nuttall
Daryl J
DJ
Kor
D000368:Aged; D015992:Body Mass Index; D001916:Brachial Artery / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D061214:Patient Safety; D059035:Perioperative Period; D017534:Radial Artery / Q000601:surgery; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome