In the management of circulatory dynamics in critically ill patients, the arterial pressure line (peripheral arterial catheter) is routinely used for continuous blood pressure measurement and frequent blood sampling.
Catheter-related bloodstream infections are widely recognized as an important complication of central venous catheters (CVCs); however, surprisingly, I don’t think we often see concrete figures regarding the actual risk of infection in arterial line catheters.
This time,Failure and complications of peripheral arterial catheters in the ICURegarding that,Introducing a 2026 systematic review/meta-analysis evaluating approximately 19,000 catheters.I will.
Documentation information
Levido A, Marsh N, Corley A, et al.
Incidence of peripheral arterial catheter failure and complications in intensive care: a systematic review and meta-analysis.
Anaesthesia. 2026;81:726–737.
DOI: 10.1111/anae.70074.
https://doi.org/10.1111/anae.70074
Background and purpose
• Peripheral arterial catheters are widely used in the ICU for blood circulation monitoring and blood sampling.
• On the other hand, compared to central venous catheter, there is insufficient research on complications such as arterial catheter failure and infection, and the incidence rate is also unclear.
• In particular, the fact that the definitions of outcomes such as “catheter failure” and “infection” have not been unified in previous studies has also been a problem.
• The purpose of this study is to evaluate the peripheral arterial catheter used in adult ICU patients.Quantifying the incidence of catheter failure and related complications by systematic review/meta-analysisis.
Research methods
• Research design: Systematic review / meta-analysis
• Target: Peripheral arterial catheter placed in adult ICU patients
• Number of studies included: 39 studies
- Observational studies: 22 studies
- Randomized controlled trial (RCT): 17 studies
• Peripheral arterial catheter used:19,018 units
• From each study, we extracted catheter failure, infectious complications, and non-infectious complications, and calculated the incidence rate using a random-effects meta-analysis.
Result
39 studies, totaling 19,018 peripheral arterial catheters, were analyzed.
The main results are as follows.
• All-cause arterial catheter failure:13.0%
(95%CI 7.6–19.5%)
• Non-infectious catheter failure:19.8%
(95%CI 12.2–28.7%)
• Catheter-associated / catheter-related bloodstream infection:1.3%
(95%CI 0.7–2.1%)
• Local infection:1.2%
(95%CI 0.4–2.4%)
In other words, blood flow infections associated with arterial pressure lines are by no means "near-zero complications," and when existing studies are integrated,About one in 100 cases have been reported as having bloodstream infection.That will happen.
Important points about infection
In this analysis, the integrated incidence of catheter-associated/catheter-related bloodstream infections was1.3%The local infection rate was **1.2%**
On the other hand, caution is required when interpreting these numbers; the definitions of bloodstream infection, catheter infection, and local infection in each study were not always uniform.
Therefore, instead of simply stating that "the infection rate in the arterial pressure line is 1.3%,"
When existing studies are integrated, approximately 1.3% cases of arterial catheter-related/suspected bloodstream infection are identified; however, there is variability among studies regarding infection definition and catheter-days reported.It is important to understand that.
Conclusion and summary
In this systematic review/meta-analysis, it was shown that peripheral arterial catheters used in the ICU can cause infection not only through infection but also through various complications including occlusion and dysfunction.
Of particular note is the fact that:
Blood stream infection: 1.3%
Local infection: 1.2%
The results show that the arterial pressure line cannot be ignored as a source of infection as well.
Furthermore, catheter failure itself is by no means uncommon, and the authors point out that there is a need for standardized outcome definitions across studies and preventive measures to reduce arterial catheter failure and complications.
Important things in the clinical field
The particularly important point in this study is that
"An A-line skirt can also be a source of blood flow infection"
That is what it means.
In severe patients who have been diagnosed with fever and sepsis, the focus tends to be on the CVCs, PICCs, urinary tract infections, pneumonia, and intra-abdominal infections; however, peripheral arterial catheters should also be evaluated as potential sources of infection.
Also, like CVC,
"Is this A-line really necessary today?"
It is important to evaluate them daily.
The arterial pressure monitor is a very common device in the ICU, butRather than assuming that peripheral arterial catheters pose little risk of infection, managing them as a single invasive intravascular device leads to patient safety.This is considered to be the case.
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