Impact of intravascular thrombosis on failure of radial arterial catheters in critically ill patients: a nested case-control study
The patency of arterial catheters is essential for reliable invasive blood pressure monitoring. We sought to determine whether radial catheter failures were associated with intravascular thrombosis in critically ill adult patients.
This unmatched case-control study was conducted within a prospective cohort of patients admitted to an intensive care unit. The arterial catheter failure was the main outcome, which identified cases. Controls were patients with patent catheter until removal or 28 days of follow-up. The prevalence of intravascular thrombosis in cases and controls was determined by ultrasonography of the cannulated radial artery. Assessors were blinded to clinical findings. Failing catheters were removed and examined microscopically.
Catheter failures occurred in 25.5% of 200 patients during 584 catheter-days (incidence rate, 87/1000 catheter-days). The median patency duration was 13.1 days. An intravascular thrombosis located in front of the catheter tip was diagnosed in 42 of 50 cases (84.0%) and 24 of 139 controls (17.3%). In multivariable logistic regression analysis, the probability of catheter failure was higher in patients with intravascular thrombosis [odds ratio (OR), 36.52; 95% confidence interval (CI), 12.86–103.74] and females (OR, 3.45; 95% CI 1.32–9.05), increased proportionally to arterial blood sampling frequency (OR, 1.20; 95% CI 1.04–1.38), and decreased in thrombocytopenia (OR, 0.28; 95% CI 0.10–0.78). After removal, 15.7% of failing catheters had some luminal fibrin deposits, but none were occluded.
Most failing radial arterial catheters had no luminal obstruction, but were associated with an intravascular thrombosis. Among predictive factors, arterial blood sampling frequency is the most susceptible to intervention.
KeywordsCatheter failure Critical care Monitoring Radial artery Thrombosis Ultrasonography
We are grateful to Prof. Laurent Brochard (Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, Ontario, Canada) for endorsing this study and providing positive feedback throughout as former Head of the Division of Intensive Care at the Geneva University Hospitals. We thank the patients, their family members and the nursing and medical staff involved in this study; Valérie Gardaz, Christelle Mounir and Claudio Andreetta (Division of Intensive Care, Geneva University Hospitals) for logistic assistance; Monique Coassin (Division of Clinical Pathology, Geneva University Hospitals) and Marie-Laure Grandgirard (Department of Communication, Fribourg Hospital) for technical support. This article is dedicated to the memory of our colleagues Sylvie Lejas and Jean-François Bellot, who were involved in the study as staff members.
All authors contributed to the study design. YF conceived the study, collected, analysed and interpreted the data, and drafted the manuscript. DA collected and contributed to the analysis and interpretation of data. HRE and MR analysed and interpreted the ultrasound images. JAL analysed and interpreted the microscopic data. CC and NDS participated in data collection. BR and AGA contributed to the interpretation of data. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no competing interest relevant to this article.
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