Arterial Catheter Outcomes in Intensive Care: What the Data Shows

Arterial catheters (ACs) are vital in intensive care units (ICUs), offering crucial access to arterial circulation for continuous blood pressure monitoring and frequent blood sampling. However, ACs also pose risks, including bloodstream infections (BSIs) and device failure. A recent analysis of data from four randomized controlled trials (RCTs) sheds light on these risks and emphasizes the need for better monitoring.

Study Overview
This study analyzed the outcomes of 1,117 adult ICU patients with arterial catheters, pooling data from trials conducted across Australian hospitals between 2011 and 2018. The main goal was to determine the incidence of AC-associated complications, particularly bloodstream infections (BSIs) and device failure, which are significant concerns in critical care settings.

Methodology
Researchers conducted a secondary analysis of data from RCTs investigating dressing and securement efficacy, as well as infusion set replacement intervals. Each patient's data was analyzed from AC insertion to removal. Key outcomes measured included the rate of bloodstream infections (BSIs) and device failure, which includes complications like dislodgement, occlusion, and inaccurate pressure readings.

Key Findings
Infection Rates: There was a low incidence of confirmed AC-BSIs, with just one case (<0.1%) of AC-BSI detected. However, the rate of laboratory-confirmed bloodstream infections (LCBI) was 2.54 per 1,000 catheter days, with Enterococcus faecalis, Escherichia coli, and Klebsiella pneumoniae being the most common pathogens.
Device Failure: AC failure occurred in 13% of patients, typically due to occlusion or poor pressure trace. AC survival rates dropped from 94% after 72 hours to 70% at 14 days, reflecting the increasing risk of failure over time.

Conclusion
The study found a relatively low incidence of serious complications related to arterial catheters, but this might be due to insufficient monitoring and underreporting. AC failure rates remain concerning, with 13% of patients experiencing device issues, leading to multiple reinsertion attempts and increased patient harm. The findings suggest that better surveillance and prospective evaluations are essential to fully understand and mitigate the risks of arterial catheters in ICUs.

Implications for Patient Care
Improved monitoring of arterial catheter outcomes is crucial for reducing patient harm. Regular assessments, better securement techniques, and tailored clinical guidelines can help reduce complications associated with these devices, ensuring better care for critically ill patients.

Authors: Samantha Keogh, Emily Larsen, Amanda Corley, Fiona Coyer, Kevin B. Laupland, Claire M. Rickard

Read More:https://www.idhjournal.com.au/article/S2468-0451(24)00050-6/fulltext