Long-term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery.

Abstract

STUDY OBJECTIVES: To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting > or = 4 days. DESIGN: Prospective, observational study of two cohorts of ICU patients. SETTING: ICU of a university hospital. PATIENTS: In a first group of 131 consecutive patients, the DPA was selected for arterial cannulation. In the second group, 134 consecutive patients were considered for radial artery cannulation. MEASUREMENTS AND RESULTS: In the DPA group, the overall success rate for catheter placement was 85%. Patients were cannulated for 16 +/- 5 days (mean +/- SD). In the radial artery group, the overall success rate was 97.7% (129 of 132 patients; p < 0.0001 vs DPA group). Patients were cannulated for 13.3 +/- 4.0 days. In both groups, no signs of ischemia were detected at the clinical examination. In the DPA group, no thrombosis was detected at the angiographic examination in 21 patients (38%), a thrombosis without vessel obstruction was observed in 21 patients (31%), and a thrombosis with vessel obstruction was observed in 21 patients (31%). In the radial artery group, no thrombosis was observed in 31 patients (24%; not significant vs DPA group), a partial thrombosis was found in 73 patients (57%), and a total thrombosis with vessel obstruction was found in 25 patients (19%). Two cases of catheter-related infection were observed in the DPA group. In the radial artery group, four cases of catheter-related infection were diagnosed vs DPA group (not significant). CONCLUSIONS: The rate of serious complications was similar for both sites of arterial cannulation. Accepting a 12.7% lower rate of successful placement, the DPA route provides a safe and easily available alternative when radial arteries are not accessible.