Arterial Line Placement In The Brachial Artery⋯ May Not Be A Safe Alternative
Kenneth P. Walsh, MD1, Daran Schiller, B.A.2, Amit S. Rao, M.D.1, Myriam Kline, PhD.3, Gregg Landis, M.D.1, Yana Etkin, M.D.1.
1Department of Vascular Surgery, Northwell Health - Long Island Jewish Medical Center, Queens, NY, USA, 2Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY, USA, 3Feinstein Institutes for Medical Research, Manhasset, NY, USA.
Arterial Line Placement in the Brachial Artery… May Not Be A Safe Alternative
Objective: To determine which anatomic site is the safest alternative for arterial line placement, when cannulation of the radial artery is not feasible.
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.
Results: A total of 3,852 arterial lines were placed: 3,148 (81.7%) radial, 447 (11.6%) femoral, 170 (4.4%) axillary and 87 (2.3%) brachial arterial lines. 2,577 lines were placed in the operating room (66.9%) and 1,275 (33.1%) were placed at the bedside. On average, the lines remained in place for 3.14 ± 5.24 days. There were 241 patients who had an arterial line placed in the same anatomic location more than once. A complication occurred following 29 (0.8%) procedures: 25 arterial occlusions, three pseudoaneurysms and one hematoma. There were no instances of arterial line infections. Five patients required surgical interventions, including four thrombectomies of occluded brachial and axillary arteries, and one stent placement for management of an axillary artery pseudoaneurysm. All the complications of radial and femoral arterial lines were treated non-surgically.
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). 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.
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 negligible risk of complications.
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