RESUMEN
BACKGROUND: Radial arterial catheters (RAC) are commonly used in emergency services and intensive care units (ICU) for continuous invasive monitoring of blood pressure and arterial blood gas sampling. Complications associated with RAC are rare. Regarding length of RAC catheters and complications, few studies were found in the literature. The present study seeks to provide health care professionals with scientific evidence to select an optimal length of RAC, based on the difference in the incidence of complications between ultrasound-guided catheters of the same diameter but different lengths. METHODS: Observational, descriptive, retrospective study. Patients older than 17 years admitted to the emergency department or ICU were included. RAC were placed with diameters of 20 gauge, between 5 and 8 cm (Arrow-Teleflex), and 22 gauge diameters between 4 and 8 cm (Vygon). Univariate analysis was made to determine behavior of the numerical variables. Normality of variables was determined through a Shapiro-Wilk-test. Qualitative variables were expressed in percentages, quantitative variables in means and standard deviation, or with median and quartiles in the case of a non-normal distribution. Chi-square or Fisher method was used for qualitative variables and the t-test for symmetric quantitative variables. Asymmetric distributions were processed with the Mann-Whitney U test. A value p < 0.05 was considered statistically significant. The statistical analysis was performed with Stata 14.1 program. RESULTS: About 793 RAC were placed between 2016 and 2019 were included, median age was 60 (37-73) (RIQ) years, 49% male. Complications were reported in all groups on average 17.5%, the most frequent being dysfunction/occlusion of the catheter. Given complications of the same diameter and different catheter lengths, there were no statistical differences between groups. CONCLUSION: Selecting one length or another with a catheter of the same diameter does not have statistically significant differences, in terms of the complications this device may cause-meaning that size does not matter.
Asunto(s)
Cateterismo Periférico , Humanos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/métodos , Catéteres de Permanencia , Ultrasonografía , CánulaRESUMEN
INTRODUCTION: Radiological studies that require contrast media are common and useful in the emergency department. Alternatives have been proposed for the administration of contrast agent in patients with difficulty in the insertion of vascular access. Since 2017, our institution has used a 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon) for venous insertion. Its ultrasound-guided insertion is carried out by emergency physicians. So far, there are no reports in the literature about the use of this long peripheral catheter for computed tomography angiography. OBJECTIVE: To describe the experience with the said device, to point out the complications associated with it, and to evaluate it as an alternative way to gain vascular access for patients with limited venous access. METHODS: An observational, analytical, and retrospective study was conducted. The study included patients who received an ultrasound-guided 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon). Transparent, radiopaque, polyethylene, 18-gauge Leadercath from Vygon, sold as peripheral arterial catheter and sometimes used "off-label" as venous catheter with a flow capacity of up to 24 mL/min, was used. The flow capacity for gravity flow is 24 mL/s; with pump-driven flow, we achieved a flow infusion of 5-6 mL/s. Univariate analyses were performed. Normality was determined through the Shapiro-Wilk test. RESULTS: In total, 172 patients met the inclusion criteria. Of them, 115 (67%) were female and the average age was 59 years. The main indication for performing the computed tomography angiography was the suspicion of pulmonary embolism (38.6%). The most frequent type of computed tomography angiography study was pulmonary tomography (88 patients, 51.5%). The contrast medium infusion rate was 6 mL/s in 51.5% (n = 88) of cases, 4.5 mL/s in 36.3%, and 5 mL/s in 12.3%. One adverse event occurred. CONCLUSION: An 18-gauge-long peripheral catheter (4 Fr × 10 cm, Leadercath; Vygon) following specific protocols appears to be safe for conducting high-flow computed tomography studies in patients with limited venous access.