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Long-term Arterial Cannulation in ICU Patients Using the Radial Artery or Dorsalis Pedis Artery^*

^* From the ICU and Anesthesia Department, Marseilles School of Medicine and Hopital Sainte Marguerite, Marseille, France.

Correspondence to: Claude Martin, MD, FCCP, Hopital Nord, Reanimation, 13915 Marseille, Cedex 20 France; e-mail: cmartin{at}ap-hm.fr

Study objectives: To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting 4 days.

Design: Prospective, observational study of two cohorts of ICU patients.

Setting: ICU of a university hospital.

Patients: In a first group of 131 consecutive patients, the DPA was selected for arterial cannulation. In the second group, 134 consecutive patients were considered for radial artery cannulation.

Measurements and results: In the DPA group, the overall success rate for catheter placement was 85%. Patients were cannulated for 16 ± 5 days (mean ± SD). In the radial artery group, the overall success rate was 97.7% (129 of 132 patients; p < 0.0001 vs DPA group). Patients were cannulated for 13.3 ± 4.0 days. In both groups, no signs of ischemia were detected at the clinical examination. In the DPA group, no thrombosis was detected at the angiographic examination in 21 patients (38%), a thrombosis without vessel obstruction was observed in 21 patients (31%), and a thrombosis with vessel obstruction was observed in 21 patients (31%). In the radial artery group, no thrombosis was observed in 31 patients (24%; not significant vs DPA group), a partial thrombosis was found in 73 patients (57%), and a total thrombosis with vessel obstruction was found in 25 patients (19%). Two cases of catheter-related infection were observed in the DPA group. In the radial artery group, four cases of catheter-related infection were diagnosed vs DPA group (not significant).

Conclusions: The rate of serious complications was similar for both sites of arterial cannulation. Accepting a 12.7% lower rate of successful placement, the DPA route provides a safe and easily available alternative when radial arteries are not accessible.

Key Words: arterial cannulation • dorsalis pedis artery • invasive monitoring • radial artery

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