Schults Jessica A, Young Emily R, Marsh Nicole, Larsen Emily, Corley Amanda, Ware Robert S, Murgo Marghie, Alexandrou Evan, McGrail Matthew, Gowardman John, Charles Karina R, Regli Adrian, Yasuda Hideto, Rickard Claire M
Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia.
School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
J Intensive Care. 2024 Mar 8;12(1):12. doi: 10.1186/s40560-024-00719-1.
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.
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.
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).
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.
动脉导管（AC）对于血流动力学监测和血液采样至关重要，但容易出现并发症。我们调查了AC功能衰竭的发生率及危险因素。
对一项多中心随机对照试验（ACTRN 12610000505000）进行二次分析。分析纳入了AC的成人重症监护病房患者亚组。主要结局是全因设备故障。次要结局包括导管相关血流感染（CABSI）、疑似CABSI、堵塞、血栓形成、意外拔除、疼痛和管路断裂。使用Cox比例风险模型和竞争风险模型研究与AC功能衰竭相关的危险因素。
664例患者中，173例（26%）出现AC功能衰竭（发生率[IR]为37/1000导管日）。疑似CABSI是最常见的故障类型（11%；IR为15.3/1000导管日），其次是堵塞（8%；IR为11.9/1000导管日）和意外拔除（4%；IR为5.5/1000导管日）。16例（2%）患者发生了CABSI。超声辅助插入可降低全因故障和堵塞的发生率（故障：调整后风险比[HR]为0.43，95%CI为0.25,0.76；堵塞：亚HR为0.11，95%CI为0.03,0.43）。年龄增加与AC功能衰竭减少相关（60 - 74岁HR为0.63，95%CI为0.44至0.89；75岁及以上HR为0.36，95%CI为0.20,0.64；参照组为15 - 59岁）。女性发生堵塞的情况更多（调整后亚HR为2.53，95%CI为1.49,4.29），而糖尿病患者发生堵塞的情况较少（SHR为0.15，95%CI为0.04,0.63）。疑似CABSI与插入部位外观异常相关（SHR为2.71，95%CI为1.48,4.99）。
AC功能衰竭很常见，超声引导插入的失败率较低。试验注册澳大利亚新西兰临床试验注册中心（ACTRN 12610000505000）；注册日期：2010年6月
