Factors Associated with Intraoperative Arterial Catheter Failure
During critical surgeries, blood pressure is often monitored continuously using a catheter placed in an artery (typically the radial artery). However, in a small but crucial proportion of surgeries, these arterial catheters fail. The patient and procedural factors associated with these intraoperative failures are inadequately understood. Our work aims at developing a better understanding of these factors. The research has progressed through 3 distinct phases. We first examined intraoperative arterial catheter failures reported as part of a Quality Improvement program. Based on information gleaned from those reports, we examined 1,000 randomly-selected medical records of patients in whom arterial catheters were placed to investigate differences between patients who had and had not experienced intraoperative failure. Finally, we began a prospective vascular ultrasound study to analyze arterial characteristics, such as diameter and blood flow, before and after cannulation and to collect ultrasound data on patients with intraoperative failure. 69% of the Quality Improvement reports involved women and 68% involved the use of long catheters. Of the randomly-selected records, intraoperative arterial catheter failure was observed in 52 patients; chi-square analysis demonstrated that the intraoperative use of heparin was significantly associated with catheter patency. We performed ultrasound imaging in 73 patients and analyzed preliminary images from another 5 patients in whom arterial catheters failed intraoperatively. In each case, extensive thrombosis of the radial artery extending to the brachial artery was observed. Statistical analysis and preliminary ultrasounds suggest that thrombosis is a meaningful contributor to intraoperative arterial catheter failure. We anticipate that the currently ongoing ultrasound study will provide more statistical data regarding risk factors and visual data regarding the proximate cause of this phenomenon. Furthermore, our results can contribute to the discussion surrounding the use of heparin in catheter flush solutions and the possibility of using thrombolytic agents to restore catheter patency.