Brachial arterial catheterization is widely chosen for constant blood pressure and hemodynamic monitoring in critically ill patients. It provides real-time measurements of physiologic parameters with a very low incidence of associated risks or complications. In this article, we will revisit its potential risks and how proper training and technical guidance can prevent issues.
Choosing the Site for Access
The treatment of ischemic heart disease has undergone several changes in recent years, including the route of arterial access for coronary angiography and percutaneous coronary interventions. The trans-radial approach (TRA) has been favored over the transfemoral approach due to its lower risk of bleeding complications, decreased hospital mortality rate, and cost-effectiveness.
The European Society of Cardiology has given a Class I recommendation for the use of TRA as the preferred method of access. However, TRA is associated with complications such as radial artery occlusion, radial artery spasm, bleeding, nerve damage, and complex regional pain syndrome. To overcome these limitations, a new approach known as the distal trans-radial approach (dTRA) or snuffbox approach has been proposed.
The main brachial artery as a point of access for catheterization has also been studied for potential benefits and risks. One such article evaluates the occurrence of occlusion at the incision site during left heart catheterization through the brachial artery which can result in significant complications. This adverse event is particularly noteworthy in individuals with severe atherosclerosis undergoing catheterization in facilities where brachial artery access is not commonly employed.
Use of Side Arm Sheath in BAC
The selection of the right sheath size for each patient is important. Using a sheath that is too small can result in complications such as hematoma formation and dissection of the access site. Meanwhile, using a sheath that is too large can lead to greater discomfort among patients and potential complications.
To help with the selection process, technical guidance is needed to determine the appropriate sheath size based on patient factors such as size, anatomy, and the type of procedure being performed. For example, larger patients will typically require a larger sheath while smaller patients may require a smaller one.
The procedure being performed can influence the sheath size as certain procedures may require larger sheaths for optimal results.
The different types of sheaths available for coronary angiography procedures include single-lumen sheaths which have one channel for the introduction of diagnostic equipment and multi-lumen sheaths which have multiple channels for the simultaneous introduction of multiple diagnostic devices.
Proper training is required to understand the specific benefits and limitations of each type of sheath. Clinicians must also note which sheaths should be used based on the requirements of the procedures that patients are scheduled to undergo.
Benefits of BAC Over Other Traditional Methods
A scientific study titled “Accuracy of the Brachial Artery Pressure Measurement” evaluated the accuracy of brachial artery catheterization for measuring blood pressure in critically ill patients. It compared blood pressure readings obtained from brachial artery catheterization with those from traditional non-invasive methods such as oscillometry and auscultation.
The study included 20 critically ill patients who underwent brachial artery catheterization. Blood pressure readings were produced using traditional non-invasive methods and brachial artery catheterization. The readings were then compared to determine the accuracy of brachial artery catheterization.
The results of the study showed that brachial artery catheterization was highly accurate in measuring blood pressure and provided reliable readings in critically ill patients. The authors also found that brachial artery catheterization was more accurate and reliable than traditional non-invasive methods, especially among patients in shock who displayed high levels of arterial pressure variability.
The authors of the study concluded that brachial artery catheterization is a valuable tool for hemodynamic monitoring among critically ill patients and provides accurate and reliable readings. They also noted that brachial artery catheterization is particularly useful in patients with shock and situations where blood pressure readings need to be obtained quickly and accurately.
Potential Risks of Brachial Artery Catheterization
The potential risks associated with BAC, most of which can be prevented with proper precautions and training, have been vastly studied.
Medical researchers have reviewed the potential complications associated with peripheral arterial catheterization, including infection, thrombosis, arterial spasm, and catheter-related arterial occlusion. More independent risk factors, including patient-related issues, such as age, comorbidities, and previous interventions, as well as catheter-related factors such as the size, type, and duration of catheterization have also been discussed.
These studies provide a comprehensive overview of peripheral arterial catheterization, including its techniques, indications, and complications. They also deeply emphasize the importance of proper technique and patient selection in minimizing the risk of complications and provide practical recommendations for the optimal use of all peripheral arterial catheters in anesthesia and intensive care medicine.
Studies also suggest the need for careful monitoring and maintenance of peripheral arterial catheters to ensure their optimal performance and minimize the risk of complications.
Learn More About Brachial Arterial Catheterization With Hospital Procedures Consultants
Proper training and technical guidance can help clinicians understand the link between the duration of catheterization and the presence of underlying medical conditions in patients. It can also lend a greater understanding of other risk factors involved in catheter-related complications.
Brachial Arterial Catheterization is one of the many hospital procedures included in Hospital Procedures Consultants’ (HPC) course. By enrolling, you can refresh and update your knowledge with evidence-based procedural education for emergency and hospital scenarios.
Explore HPC’s website for live, online, and custom courses.
References
Sing, A; Wakefield, B; Duncan, A . Complications from brachial arterial pressure monitoring are rare in patients having cardiac surgery. J Thorac Dis. 2018; 10(2): E158 – E159
Folland,ED; Kemper, A; Bloomfield, P; Parisi, A. Brachial artery catheterization employing a side arm sheath. Cathet Cardiovasc Diagn, 1984. 10(1):55-61
Brachial Arterial Line: A Systematic Review of Sorts – Eddy Joe MD
Nairouk, Z. Distal Radial Artery Access: The Future of Cardiovascular Intervention, Cureus. 2020. 12(3)
Volker Scheer, B. Perel,A – Pfeiffer, U. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Cri Care. 2002. 6(3): 199-204.
Lakhal, K. Robert-Edan,V. Invasive monitoring of blood pressure: a radiant future for brachial artery as an alternative to radial artery catheterisation?. J Thorac Dis. 2017 Dec; 9(12): 4812–4816
Roy,S. Kabach,M. Patel,D. Radial Artery Access Complications: Prevention, Diagnosis and Management. Cardiovasc Revasc Med.. 2022 Jul;40:163-171
Harvey,J. Kim, S. Ireson, M. Gulati,R. Acute Upper-Limb Complications Following Radial Artery Catheterization for Coronary Angiography. J Hand Surg Am. 2020 Jul;45(7):655.e1-655.e5
Handlogten, K. Wilson,G. Brachial artery catheterization: an assessment of use patterns and associated complications. Anesth Analg. 2014 Feb;118(2):288-295