Reducing the Use of Arterial Lines in the ICU
December 1, 1999 3 minutes read
Reducing the Use of Arterial Lines in the ICU
Abstract & Commentary
Synopsis: Implementing a protocol for intra-arterial catheter placement that restricted its use to published indications resulted in substantially fewer catheters being placed, with no change in the frequency of arterial blood gas measurement or other outcome.
Source: Ozgun EM, et al. Respir Care 1999;44(10): 1193-1197.
Ozgun and colleagues at the medical university of South Carolina studied the effect of a standardized protocol for the placement of indwelling arterial catheters on catheter usage, the frequency of arterial blood gases, and patient outcomes in their medical intensive care unit (ICU). Under the protocol, placement of arterial catheters was restricted to four indications formulated from a literature review: persistent hypotension requiring pressors, hypertensive emergencies requiring the use of rapidly acting intravenous agents to lower the blood pressure, controlled hypotension and other situations requiring titration of arterial blood pressure within a narrow range, and the need for more than five blood draws per day. Data were collected for four months before and four months after the protocol restricting catheter placement was put into effect.
A total of 252 patients were admitted 292 times to the medical ICU during the study period. After exclusion of 32 admissions because data were missing or because an arterial catheter had been placed prior to arrival on the unit, there were 133 preprotocol admissions and 124 admissions after the protocol was implemented. Patients in these two groups were similar in terms of age; gender; severity of illness by APACHE III, APS, and TISS scores; and need for mechanical ventilation. The number of intra-arterial catheters placed was significantly lower after the protocol took effect (39/133 vs 17/124; P = 0.004). There were no other statistically significant differences in any study variable, including number of arterial blood gases drawn per admission (a mean of 7.0 in the control group vs 5.6 in the protocol group; P = 0.23).
COMMENT BY DAVID J. PIERSON, MD, FACP, FCCP
This study shows that the use of intra-arterial catheters for monitoring and blood draws can be substantially reduced in medical ICU patients through the use of specific, standardized, unit-wide placement criteria based on published indications. Although previous studies (mainly in surgical ICU patients) have shown that the presence of an arterial line increases the number of arterial blood gas specimens drawn, even when severity of illness and other factors are taken into account, such was not the finding in this study. This discrepancy is explained by Ozgun et al by the more uniform patient population and physician practice in their study than in previous investigations, and by the requirement that all arterial blood specimen draws required a specific physician order. Many units have standing orders for drawing arterial blood specimens at the caregiver’s discretion. A previous study (Browning JA, et al. Respir Care 1989;34[4]:269-276) showed that the number of inappropriate arterial blood gas analyses could be reduced by educating caregivers on the indications for this procedure.
Implementation of a protocol for placement of intra-arterial catheters:
a. reduced the mean duration of mechanical ventilation from 7.4 to 4.8 days.
b. increased ICU length of stay by a mean of 0.8 days.
c. significantly reduced the number of arterial blood gas analyses.
d. All of the above
e. None of the above
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