A COMPARISON OF ARTERIAL LINES AND INSERTION TECHNIQUES IN CRITICALLYILL PATIENTS

We compared three arterial line insertion techniques and two types of arterial catheters in 69 critically ill patients. Use of the direct-pu ncture technique (method A) was associated with a significantly higher failure rate (23%) than use of a catheter with a separate guide wire (method B, 'classical' Seldinger technique, p < 0.001) or a catheter w ith an integral guide wire (method C, 'modified' Seldinger technique, p < 0.02). Operators randomly allocated to using method A took signifi cantly longer to perform the procedure than those using method C (p < 0.01), used significantly more catheters (p < 0.0001) and made signifi cantly more punctures in achieving a successful insertion than those u sing either methods B (p < 0.001) or C (p < 0.001). Both catheter type s B and C (polyurethane) were significantly less likely to block, thus requiring re-insertion, than catheter type A (Teflon) (p < 0.02, p < 0.01 respectively). We recommend the use of a 'classical' Seldinger te chnique (method B) for arterial line insertion in critically ill patie nts and the use of a polyurethane catheter, in preference to Teflon, t o maximise catheter life after insertion.