Arterial line placement in the brachial artery - may not be a safe alternative Daran Schiller,
1 B.A. ,
2 M.D. ,
2 M.D. ,
Kenneth Walsh Amit Rao, Myriam Kline, PhD 2 2 Gregg Landis, M.D. , Yana Etkin, M.D. .
3,
1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Department of Vascular Surgery, Northwell Health - Long Island Jewish Medical Center 3Feinstein Institutes for Medical Research
Background The use of indwelling arterial catheters for pressure monitoring is a routine practice, with about a third of patients in intensive care receiving an arterial line (1). Radial arterial lines are the most common lines placed, due to extensive collateral circulation and its peripheral, superficial location (2). Alternative sites of arterial line placement include the ulnar, brachial, axillary, femoral, dorsalis pedis, posterior tibial, and temporal arteries (2-3). However, there are inherent risks with any invasive procedure, and complications such as arterial thrombosis, infection, hematoma and pseudoaneurysm (2).
Results Artery Accessed
Frequency Accessed (% Number of of total) Complications (% rate)
Radial Femoral Axillary Brachial
3148 (81.7) 447 (11.6) 170 (4.4) 87 (2.6)
19 (0.6) 2 (0.4) 3 (1.8) 5 (5.7)
Table 1. Patients who underwent arterial line placement in the brachial artery were significantly more likely to experience a complication, as compared to those who had a radial arterial line (OR: 10.174; 95% CI: 3.854 - 26.857, p<0.0001). On average, the lines remained in place for 3.14± 5.24 days.
Goals This large-scale retrospective study sets out to determine which of the femoral, brachial, or axillary arteries are the safest alternative for arterial line placement when cannulation of the radial artery is not feasible.
Conclusions Arterial line placement is a relatively safe procedure. However, line placement in the brachial artery should be avoided if possible. In situations where the radial artery cannot be accessed, the femoral artery serves as a viable alternative and carries a low risk of complications.
Future Direction %
Methods A retrospective review was conducted of patients who underwent arterial line placement between September 2018 and October 2019 at a tertiary academic medical center. Descriptive statistics were used to characterize patients' demographics and procedural data. Complications, as well as subsequent interventions were analyzed. Logistic regression with Firth likelihood was used to model the occurrence of an arterial line complication based on selected predictor variables such as demographics, artery accessed, laterality and the setting in which the line was placed.
Age, sex, laterality, the setting of line placement (operating room vs. bedside), and the duration that the arterial line remained in place were not predictive of complications.
Future studies should include the cause of admission and acuity of the patient as risk factors, to shed more light on the relative safety of alternative anatomical sites for arterial line placement.
Resources Figure 1. A complication occurred following 29 (0.8%) procedures: 25 arterial occlusions, three pseudoaneurysms and one hematoma. Five patients required surgical interventions, which includes three brachial artery thrombectomies and one axillary artery thrombectomy, along with a stent placement for management of an axillary artery pseudoaneurysm. All the complications of radial and femoral arterial lines were treated non-surgically.
There was no significant difference in the rate of complications Figure 7: Independent CRISPR knockout of CDK4 or CDK6 of axillary orinfemoral lines when compared to radial lines. does not cause dropout most breast cancer cell lines studied.
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