Brachial artery catheters appear to be significantly more reliable than radial artery catheters in the cardiac surgery population, especially post-CPB.
That said, there is some concern about the safety of brachial artery catheters, primarily related to the lack of collateral circulation and proximity to the median nerve, which may be punctured in 1-2% of cases (paresthesias are common, nerve palsies are rare). According to both Miller and Irwin and Rippe, however, centers with significant experience in using this vessel have reported complication rates identical to other cannulation sites. Despite this, because of the theoretical risks, use of ultrasound may be prudent.
A slightly longer catheter should be used, to ensure that the catheter traverses the elbow joint
The infectious risk of arterial catheters is generally under appreciated – in fact, the colonization rate of arterial catheters (15.7 per 1000 catheter days) is the essentially the same as for central venous catheters (16.8 per 1000 catheter days). The risk of catheter-related blood stream is supposedly lower but non-trivial (0.92:1000 versus 2.23:1000 catheter days). Thus, the 2×2 factorial randomized controlled trial comparing chlorhexidine-impregnated sponges and less frequent dressing changes to traditional management of intravascular catheters included these sponges on the arterial catheters, and showed that chlorhexidine-impregnated sponges on both the arterial and central venous catheters lowers CRBSI from 1.4:1000 to 0.6:1000 catheter days.
Complications of Brachial Artery Cannulation
- Vascular: clinical ischemia (highly unlikely, even if pulses are diminished)
- Nerve Injury: median nerve located in antecubital fossa. 1-2% risk of injury, generally only paresthesia
- Infection: as with all intravascular catheters (consider a BioPatch)
References
- M G Bazaral, M Welch, L A Golding, K Badhwar Comparison of brachial and radial arterial pressure monitoring in patients undergoing coronary artery bypass surgery. Anesthesiology: 1990, 73(1);38-45 PubMed Link
- David Boon Chai Koh, John R Gowardman, Claire M Rickard, Iain K Robertson, Andrew Brown Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Crit. Care Med.: 2008, 36(2);397-402 PubMed Link
- Jean-François Timsit, Carole Schwebel, Lila Bouadma, Arnaud Geffroy, Maïté Garrouste-Orgeas, Sebastian Pease, Marie-Christine Herault, Hakim Haouache, Silvia Calvino-Gunther, Brieuc Gestin, Laurence Armand-Lefevre, Véronique Leflon, Chantal Chaplain, Adel Benali, Adrien Francais, Christophe Adrie, Jean-Ralph Zahar, Marie Thuong, Xavier Arrault, Jacques Croize, Jean-Christophe Lucet, Dressing Study Group Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA: 2009, 301(12);1231-41 PubMed Link
- M G Bazaral, M Welch, L A Golding, K Badhwar Comparison of brachial and radial arterial pressure monitoring in patients undergoing coronary artery bypass surgery. Anesthesiology: 1990, 73(1);38-45 PubMed Link
Other References
- Keys to the Cart: November 13, 2017; A 5-minute video review of ABA Keywords Link
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