UMEM Educational Pearls

Title: A-lines: A Significant Source of Preventable Blood Stream Infections

Keywords: arterial line, catheter related blood stream infections (PubMed Search)

Posted: 1/20/2014 by John Greenwood, MD (Updated: 1/21/2014)
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Arterial Catheter-Related Blood Stream Infections

Whether arterial lines are a potential source of catheter-related blood stream infections (CRBSIs) is highly-debated; however, based on a recent systematic review they are an under recognized and significant source of CRBSIs.

Incidence: In systematically cultured arterial catheters, the infection rate was 1.6 infections/1,000 catheter days which is similar to what has been reported for infections associated with short-term CVC's.
Location: Femoral a-lines are more likely than radial a-lines to be a source of a CRBSI. Femoral a-line CRBSIs occurred in 1.5% of all catheters (95% CI, 0.8–2.2%), which is higher than radial CRBSI, with a relative risk of infection 1.94 times greater than those placed at the radial site.
Technique: Only one study specifically evaluated the impact of full barrier precautions versus using sterile gloves only for peripheral a-lines, and it did not find any significant difference in BSI. No study has evaluated the impact of maximal barrier precautions for femoral, axillary, and brachial arterial catheters.
Dressing: The risk of infection was significantly decreased with the use of chlorhexidine-impregnated dressings (ex: BioPatch).

Bottom Line(s)

Arterial lines appear to be a significantly under recognized source of CRBSI's in critically-ill patients. If you are deciding to place an a-line for invasive blood pressure monitoring, strongly consider the radial site and use a chlorhexidine sponge or dressing to try and minimize the risk of future BSI.
There is a paucity of data regarding the utility of maximal barrier techniques when inserting peripheral arterial lines. With arterial catheter infection rates approaching that of central venous catheters, we should probably be inserting a-lines with the same sterile technique.

References

O'horo JC, Maki DG, Krupp AE, Safdar N. Arterial Catheters as a Source of Bloodstream Infection: A Systematic Review and Meta-Analysis. Crit Care Med. 2014.

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