From the Research
Advancing a partially retracted arterial line over a wire is not recommended due to the increased risk of complications, including catheter-related bloodstream infections, arterial infections, and thrombosis. The safest approach is to completely remove the partially retracted arterial line and place a new line using a fresh, sterile kit and technique. This approach minimizes the risk of introducing pathogens into the bloodstream and reduces the likelihood of catheter damage, fragmentation, or embolization. Some key points to consider when dealing with a partially retracted arterial line include:
- The risk of thrombosis and arterial line complications is higher in certain patient populations, such as those with COVID-19, as shown in a study published in 2023 1.
- The use of guidewires can be associated with complications, including loss of the guidewire, as reported in a case review published in 2013 2 and 2011 3.
- The choice of arterial line site, such as radial or femoral, can affect the risk of complications, with femoral lines potentially having a lower failure rate, as shown in a study published in 2018 4.
- The overall risk of complications, including infection, bleeding, and vascular insufficiency, should be carefully considered when managing arterial lines, as highlighted in a study published in 1998 5. If arterial access must be maintained, alternative approaches include securing the current line at its partially retracted position (if still functional and in the artery), placing a new arterial line at a different site, or having an experienced provider attempt ultrasound-guided placement of a new line at the same site following complete removal of the retracted catheter.