Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

by Joseph Esherick, M.D., FAAFP, FHM

Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine antisepsis, sterile gloves, a sterile gown, a surgical cap, a surgical mask, and a large sterile drape during the insertion procedure. These are similar guidelines to the CDC guidelines for central line insertion. An anonymous survey was conducted to determine infection prevention methods used by clinicians in ICUs during arterial catheter insertion.

Physicians, nurse practitioners, physician assistants, respiratory therapists, and registered nurses who are registered to receive e-mails from Society of Critical Care Medicine were sent the web-based survey. Of the 1,029 eligible participants, 44% disclosed they use the CDC’s recommended barrier precautions while inserting arterial catheters, while only 15% claimed to use full barrier precautions. The surveyed intensivists estimated arterial line associated bloodstream infection rate to be 0.3 infections per thousand catheter-days.

Conclusively, the CDC guidelines for barrier precautions during arterial catheter insertions are not being not consistently adhered to. According to the survey results, less than half of the clinicians who replied are taking the necessary measures to reduce the risk of arterial line-associated infections. Since arterial lines carry the same risk of bloodstream infections as central lines, all clinicians should use maximal barrier precautions during placement of either a central line or an arterial line.

Cohen et al.Arterial Catheter Use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk Critical Care Medicine. E-Pub, 2015