Radial Arterial Lines Have a Higher Failure Rate than Femoral

Abstract

IntroductionArterial lines are important for monitoring critically ill patients. They are placed most commonly in either femoral or radial sites, though there is little evidence to guide site preference.MethodsThis is an ambispective, observational, cohort study to determine variance in failure rates between femoral and radial arterial lines. This study took place from 2012 to 2016 and included all arterial lines placed in adult patients at a single institution. Causes of line failure were defined as inaccuracy, blockage, site issue, or accidental removal. The primary outcome was line failure by location. Secondary outcomes included time to failure and cause of failure.ResultsWe evaluated 272 arterial lines over both arms of the study. Fifty-eight lines eventually failed (21.32%). Femoral lines failed less often in both retrospective (5.36% vs 30.71%) and prospective (5.41% vs. 25.64%) arms. The absolute risk reduction of line failure in the femoral site was 20.2% (95% confidence interval [3.7 – 36.2%]). Failures occurred sooner in radial sites compared to femoral. Infection was not a significant cause of removal in our femoral cohort.ConclusionFemoral arterial lines fail much less often then radial arterial lines. If placed preferentially in the femoral artery, one line failure would be prevented for every fourth line.

Arterial line insertion

“…14 Advantages of femoral arterial line insertion are potentially lower risk of catheter failure. 15,16 In one retrospective study there was a 5% failure rate for femoral arterial lines compared to 30% for radial lines, without an increase in infection. 15 There may also be a lower risk of accidental dislodgement.…”

“…15,16 In one retrospective study there was a 5% failure rate for femoral arterial lines compared to 30% for radial lines, without an increase in infection. 15 There may also be a lower risk of accidental dislodgement. 17 Traditionally femoral has not been the preferred site due to infection risk from proximity to the perineum.…”

“…However, the evidence regarding infection rates in femoral lines is conflicted, as several studies have shown no increase in infection rates compared to radial placement. 9,15 The ulnar artery is generally not preferred due to its tortuous course but may be a viable alternative where a pulse is palpable. 8 The brachial artery may be considered as an alternative site, although this has not been preferred traditionally due to absence of collateral circulation.…”

“…Traditionally femoral has not been the preferred site due to infection risk from proximity to the perineum. However, the evidence regarding infection rates in femoral lines is conflicted, as several studies have shown no increase in infection rates compared to radial placement 9,15 …”