Since I’ve started working at my new institution, I’ve placed two brachial arterial lines and an axillary line. As any intensivist will admit, if you’re looking elsewhere from the radial, it means that the patient is pretty sick and you need some results quickly.
While performing this procedure, I’ve received strange looks from the nurses as they are unfamiliar with the location. Where I trained, I saw anesthesia commonly place these without any issues in the cardiac surgery population. I decided to do a bit of a search for the data behind the safety of this procedure.
First of all, why should we worry? The brachial artery lacks collateral circulation. As with any other line, we worry about clinical ischemia, nerve injury (which is the median nerve in the case of the brachial artery), and infection. What’s the data behind these, though?
Here are some of the more recent studies. I’ll let you all decide for yourselves after you read the articles. Thanks to the authors!
Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine
Published in 2002 in Critical Care. This is an open access article. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137445/pdf/cc1489.pdf “Only one serious complication was found in a study of 1000 patients in which the brachial artery was used for invasive monitoring in ambulatory patients. This complication was an infected haematoma arising from a pseudoaneurysm. Another study that employed the brachial artery for arterial blood sampling in 6185 patients also showed a small number of complications (incidence 0.2%), mainly paresthesias.”
Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications
I cannot obtain full access to this study published in June of 2017 but it can be found here: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2618830 Review of their abstract shows that their study population was exclusively in cardiac surgery patients and they looked at vascular issues, nerve injury, and infections as complications They concluded that “Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications.”
Brachial Artery Catheterization: An Assessment of Use Patterns and Associated Complications
Published in 2012 in Anesthesia and Analgesia. This is open access so you can obtain a copy for yourself!
This was a retrospective study with 858 patients. “the overall rate of vascular and neurologic complications was low in both brachial and radial artery catheterization groups (3 [0.35%] vs 1 [0.03%], brachial versus radial, respectively; P = 0.03). No cases of catheter-related bloodstream infection were identified in either cohort.”
There are some older studies which I need to briefly glance at but I wanted to get this out there and I’ll add some more goodies later. Hope this helps provide some education on brachial arterial line placement. Learn how to use it for resuscitation and fluid responsiveness on this post.
This was initially written in October 2010. -EJ
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