Arterial catheter outcomes in intensive care: An analysis of 1117 patients.

Background: Access to arterial circulation through arterial catheters (ACs) is crucial for monitoring and decision-making in intensive care units (ICU) but carries the risk of complications including bloodstream infection (BSI).
Methods: We conducted a secondary analysis of data from four randomised controlled trials in Australian ICUs, investigating the efficacy of different AC interventions. De-identified data were combined into a single dataset, and per-patient outcomes analysed. The primary outcome was AC-BSI, defined as laboratory confirmed bloodstream infection (LCBI) type 1 or 2, with a concurrent local infection. All-cause AC failure was defined as any unplanned removal. AC infection and failure were reported as rates per 1000 catheter days and hours.
Results: Data from 1117 adult patients were analysed. Mean age was 58.8 years (±16.6); and 41% (n = 462) were male. Median AC dwell time was 110 h (IQR 28.3-168.0). There was one case (<0.1%; 0.18/1000 catheter days [95% CI 0.03-1.29]) of AC-BSI, and 14 cases of LCBI (1%; 13 LCBI-1 and 1 LCBI-2; 2.54/1000 catheter days [95% CI 1.51-4.30]). LCBI were most commonly Enterococcus faecalis; Escherichia coli and Klebsiella pneumoniae. There were four cases of local infection (<1%; 0.73/1000 catheter days [95% CI 0.27-1.94]). Overall AC failure rate was 13% (n = 146) or 26.53/1000 catheter days (95% CI 22.56-31.20).
Conclusion: This study identified a relatively low incidence of complications. This is likely reflective of poor monitoring of ACs in intensive care. Better surveillance and a rigorous prospective evaluation of AC outcomes is required to understand the true risk ACs pose to critically ill patients.
Competing Interests: Declaration of competing interest SK reports monies received in the last three years by her employer (QUT) from BD Medical and ITL Biomedical for educational consultancies unrelated to this study. EL's affiliate (University of Queensland) has received, on her behalf, an investigator-initiated research grant from Eloquest Healthcare, unrelated to this work. EL was also awarded scholarship for conference attendance by Angiodynamics. All unrelated this study. AC's employer (Griffith University) has received, on her behalf, investigator-initiated grants from Cardinal Health, 3M, and Eloquest (all unrelated to current project). NM declares that affiliate's Griffith University and the University of Queensland have received on her behalf investigator-initiated grants from 3M, Cardinal Health and Eloquest, and payment from 3M for an educational consultancy (all unrelated to this study). FC declares monies received by her employer (UQ) from Molnlycke on her behalf for consultancy unrelated to this study. CMR reports monies received by her current and past employer (University of Queensland and Griffith University) as unrestricted investigator-initiated research or educational grants on her behalf from 3M; Eloquest, BD, Cardinal Health, and consultancy payments for lectures or expert opinion from BBraun, BD and ITL Biomedical. All other authors having nothing to declare.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)