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Critical Care |

A Survey on Arterial Lines: What Is Everyone Else Doing?

Josebelo Chong; Marvin Balaan
Author and Funding Information

Allegheny General Hospital, Pittsburgh, PA


Chest. 2014;146(4_MeetingAbstracts):243A. doi:10.1378/chest.1989734
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Abstract

SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: In placing arterial catheters the critically ill, the radial artery is usually the preferred site, followed by the femoral and axillary arteries. However, the CDC guidelines from 2011 recommend the radial, brachial, and dorsalis pedis sites first, followed by the femoral and axillary. We sought to examine the knowledge, attitudes, and practices relating to arterial catheter placement.

METHODS: In January 2014, the IRB-approved survey was disseminated via email to Pulmonary and Critical Care Medicine Program Directors across the United States, who were asked to disseminate it throughout their departments.

RESULTS: A total of 250 respondents completed the survey, consisting mostly of fellows-in-training and attending physicians. Most reported practicing in a university-affiliated teaching hospital and using arterial catheters in a medical ICU. Geographic groupings were based on US Census Bureau regions. The first site of choice for arterial catheter insertion was the radial (90%), followed by the axillary (4%), and the femoral (3%). A regional distribution was noted: of the respondents who indicated their preference for the axillary as their first site, 67% were from the Northeast. The second site of choice was the femoral (66%), followed by the brachial (12%), and the axillary (9%). A regional distribution was also noted: of the respondents who indicated their preference for the axillary as their second site, 43% were from the Northeast. The main reasons for site preference were technical proficiency and concern about possible adverse effects. Most of the respondents reported having had a previous complication with an arterial catheter, with limb ischemia being the most common. Only 16% of respondents correctly identified the current CDC recommendations.

CONCLUSIONS: Our results confirm previous findings that the radial, femoral, and axillary arteries are the sites of choice for arterial catheterization. The main drivers for site selection seem to be technical proficiency and concern for possible adverse effects. Current practices for for site selection are at odds with existing CDC guidelines. Awareness of these guidelines is also very low. A regional variation to site selection also appears to exist, with preference for the axillary artery clustering in the Northeast.

CLINICAL IMPLICATIONS: Additional guidelines may need to be developed that take technical factors and non-infectious complications into account. The reasons for and significance of the regional variation may need further investigation.

DISCLOSURE: The following authors have nothing to disclose: Josebelo Chong, Marvin Balaan

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