Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial
Abstract 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). Anal...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-024-00719-1 |
| _version_ | 1797266934802153472 |
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| author | Jessica A. Schults Emily R. Young Nicole Marsh Emily Larsen Amanda Corley Robert S. Ware Marghie Murgo Evan Alexandrou Matthew McGrail John Gowardman Karina R. Charles Adrian Regli Hideto Yasuda Claire M. Rickard the RSVP Study Investigators |
| author_facet | Jessica A. Schults Emily R. Young Nicole Marsh Emily Larsen Amanda Corley Robert S. Ware Marghie Murgo Evan Alexandrou Matthew McGrail John Gowardman Karina R. Charles Adrian Regli Hideto Yasuda Claire M. Rickard the RSVP Study Investigators |
| author_sort | Jessica A. Schults |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-25T01:08:35Z |
| format | Article |
| id | doaj.art-af4b81a0af9d427e8f3aa7939d4208d1 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-25T01:08:35Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-af4b81a0af9d427e8f3aa7939d4208d12024-03-10T12:06:58ZengBMCJournal of Intensive Care2052-04922024-03-011211910.1186/s40560-024-00719-1Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trialJessica A. Schults0Emily R. Young1Nicole Marsh2Emily Larsen3Amanda Corley4Robert S. Ware5Marghie Murgo6Evan Alexandrou7Matthew McGrail8John Gowardman9Karina R. Charles10Adrian Regli11Hideto Yasuda12Claire M. Rickard13the RSVP Study InvestigatorsMetro North Health, Herston Infectious Disease InstituteSchool of Medicine and Dentistry, Griffith UniversitySchool of Nursing, Midwifery and Social Work, The University of QueenslandAlliance for Vascular Access Teaching and Research GroupSchool of Nursing, Midwifery and Social Work, The University of QueenslandSchool of Medicine and Dentistry, Griffith UniversityMetro North Health, Herston Infectious Disease InstituteSchool of Nursing, University of WollongongRural Clinical School, The University of QueenslandIntensive Care Service, Royal Brisbane and Women’s HospitalSchool of Nursing, Midwifery and Social Work, The University of QueenslandDepartment of Intensive Care, Fiona Stanley HospitalDepartment of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical CenterMetro North Health, Herston Infectious Disease InstituteAbstract 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.https://doi.org/10.1186/s40560-024-00719-1Arterial catheterSecondary analysisComplicationHealthcare associated infectionIntensive care |
| spellingShingle | Jessica A. Schults Emily R. Young Nicole Marsh Emily Larsen Amanda Corley Robert S. Ware Marghie Murgo Evan Alexandrou Matthew McGrail John Gowardman Karina R. Charles Adrian Regli Hideto Yasuda Claire M. Rickard the RSVP Study Investigators Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial Journal of Intensive Care Arterial catheter Secondary analysis Complication Healthcare associated infection Intensive care |
| title | Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial |
| title_full | Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial |
| title_fullStr | Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial |
| title_full_unstemmed | Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial |
| title_short | Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial |
| title_sort | risk factors for arterial catheter failure and complications during critical care hospitalisation a secondary analysis of a multisite randomised trial |
| topic | Arterial catheter Secondary analysis Complication Healthcare associated infection Intensive care |
| url | https://doi.org/10.1186/s40560-024-00719-1 |
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