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Observational Study
. 2018 Mar;19(2):364-371.
doi: 10.5811/westjem.2017.11.34727. Epub 2018 Feb 20.

Radial Arterial Lines Have a Higher Failure Rate than Femoral

Matthew R Greer  1 , Scott Carney  1 , Rick A McPheeters  1 , Phillip Aguiniga  2 , Stephanie Rubio  2 , Jason Lee  2
Affiliations
Observational Study

Radial Arterial Lines Have a Higher Failure Rate than Femoral

Matthew R Greer et al. West J Emerg Med. 2018 Mar.

Abstract

Introduction: Arterial 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.

Methods: This 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.

Results: We 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.

Conclusion: Femoral 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.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Retrospective patient selection for comparison of radial vs. femoral arterial lines.
Figure 2
Figure 2
Arterial line failure by site from retrospective data. Femoral lines failed 5.36% of the time (3 of 56) as compared to radial lines, which failed 30.17% of the time (43 of 140).
Figure 3
Figure 3
Arterial line failure by site from prospective data. Femoral lines failed 5.41% of time (2 of 37) as compared to radial lines, which failed 25.64% of the time (10 of 39).
Figure 4
Figure 4
Arterial line failure as % of total, with hashed areas representing failure rates. Femoral failure rates are proportionally much smaller than their radial counterparts.
See this image and copyright information in PMC

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