Brachial artery catheters: Are they a safe alternative?

Objective: To determine whether or not the brachial artery is an acceptable alternative for cannulation when the radial artery is felt to be unsuitable. Methods: Retrospective review of patients in the surgical intensive care unit at the Veterans Administration Hospital in Minneapolis, Minnesota. Results: Utilising an 'on line, over the needle' technique, 3,570 upper extremity arterial lines were placed over a four-year period. There were 36 complications noted in 2,031 brachial artery lines compared with 16 complications in 1,539 radial artery lines. The complications that were reviewed included infection, bleeding, paraesthesia and ischaemia. By χ² analysis, the overall complication rates between the two groups were not significantly different (p = 0.07). However, subset analysis revealed that there was a significantly higher incidence of ischaemic complications in the brachial arterial line group (p = 0.015). Conclusion: Based on these results we conclude that the brachial artery is not an acceptable alternative for arterial cannulation when the radial artery cannot be used. Alternative sites include the femoral artery, the dorsalis pedis artery and the axillary artery.