TY - JOUR
T1 - Risk factors for arterial catheter failure and complications during critical care hospitalisation
T2 - a secondary analysis of a multisite, randomised trial
AU - the RSVP Study Investigators
AU - Schults, Jessica A.
AU - Young, Emily R.
AU - Marsh, Nicole
AU - Larsen, Emily
AU - Corley, Amanda
AU - Ware, Robert S.
AU - Murgo, Marghie
AU - Alexandrou, Evan
AU - McGrail, Matthew
AU - Gowardman, John
AU - Charles, Karina R.
AU - Regli, Adrian
AU - Yasuda, Hideto
AU - Rickard, Claire M.
N1 - Funding Information:
JAS, ERY, RSW, MM, MM, JG, KRC, AR, HY have no conflicts to disclose. NM: Griffith University and The University of Queensland have received on her behalf investigator-initiated grants from 3 M, Cardinal Health and Eloquest, and consultancy payments from 3 M and Becton Dickinson for expert advice/ educational sessions. EL: 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, unrelated to this work. AC: ACs employer, on my behalf, has received investigator-initiated grants from 3 M, Cardinal Health and Eloquest Healthcare. These grants are unrelated to this work. EA: EA’s employer (Southwestern Sydney Local Health District) has received investigator-initiated research grants from Becton Dickinson-Bard and Eloquest Healthcare. EA has also received consultancy payments for educational lectures/expert advice from 3 M and ITL medical. CMR: CMR’s employer’s (Griffith University or The University of Queensland) received on her behalf unrestricted research or education grants from 3 M, BD-Bard, Cardinal Health, Eloquest and consultancy payments from 3 M, BD-Bard and ITL Healthcare.
Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Objectives: Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. Methods: Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. Results: Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60–74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15–59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). Conclusions: AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
AB - Objectives: Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. Methods: Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. Results: Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60–74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15–59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). Conclusions: AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
KW - Arterial catheter
KW - Complication
KW - Healthcare associated infection
KW - Intensive care
KW - Secondary analysis
UR - http://www.scopus.com/inward/record.url?scp=85186913240&partnerID=8YFLogxK
U2 - 10.1186/s40560-024-00719-1
DO - 10.1186/s40560-024-00719-1
M3 - Article
C2 - 38459599
AN - SCOPUS:85186913240
SN - 2052-0492
VL - 12
JO - Journal of Intensive Care
JF - Journal of Intensive Care
IS - 1
M1 - 12
ER -