Perioperative Medicine  |   March 2016
Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults
Author Notes
  • From the Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
  • Corresponding article on page 528.
    Corresponding article on page 528.×
  • Submitted for publication April 2, 2015. Accepted for publication October 22, 2015.
    Submitted for publication April 2, 2015. Accepted for publication October 22, 2015.×
  • Address correspondence to Dr. Nuttall: Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. gnuttall@mayo.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Infectious Disease / Technology / Equipment / Monitoring / Quality Improvement
Perioperative Medicine   |   March 2016
Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults
Anesthesiology 3 2016, Vol.124, 590-597. doi:10.1097/ALN.0000000000000967
Anesthesiology 3 2016, Vol.124, 590-597. doi:10.1097/ALN.0000000000000967
Abstract

Background: Prior research has provided inconsistent data regarding the risk factors associated with complications from arterial cannulation. The goal of this study was to clearly define the incidence and risks factors associated with arterial cannulation complications.

Methods: After obtaining institutional review board approval, all patients requiring arterial line placement with documentation were included in this retrospective study between January 1, 2006, and December 31, 2012. Leveraging two robust data warehouses, the Perioperative DataMart and the Mayo Clinic Life Silences System, the authors cross-matched arterial line cannulation with a documented vascular consult, neurologic consult, infection, or return to surgery within 30 days in order to identify the initial patient population.

Results: A total of 62,626 arterial lines were placed in 57,787 patients, and 90.1% of the catheters placed were 20-gauge catheters. The radial artery was cannulated in 94.5% of patients. A total of 21 patients were identified as having experienced vascular complications or nerve injuries, resulting in a complication rate of 3.4 per 10,000 (95% CI, 2.1 to 5.1). Cardiac surgery had the largest number of catheters placed (n = 15,419) with 12 complications (complication rate = 7.8 per 10,000; 95% CI, 4.0 to 13.6). The rate of complications differed significantly (P < 0.001) across the three most common catheter sizes (2.7 per 10,000 [95% CI, 1.5 to 4.4] for 20 gauge, 17.2 per 10,000 [95% CI, 4.7 to 43.9] for 18 gauge, and 9.4 per 10,000 [95% CI, 1.1 to 34.1] for 5 French).

Conclusion: In a large retrospective study, the authors document a very low rate of complications with arterial line placement.

Abstract

In a series of 57,787 patients receiving arterial cannulation, 21 patients were identified as having experienced vascular complications or nerve injuries, resulting in a very low complication rate of 3.4/10,000. The rate of complications differed significantly (P < 0.001) across the three most common catheter sizes (2.7/10,000 for 20 gauge, 17.2/10,000 for 18 gauge, and 9.4/10,000 for 5 French). Given the low frequency of complications observed, the current study does not have sufficient statistical power to make definitive conclusions regarding the risk factors (listed in the appendix).