From the Guidelines
Arterial blood draws from the brachial artery in the upper arm are associated with significant risks, including vascular complications, nerve damage, and compartment syndrome, and are generally not recommended as a first-choice site. The primary risks include damage to adjacent structures, as the brachial artery runs close to the median nerve and brachial vein, which can cause severe pain, numbness, and potential long-term motor dysfunction in the hand and fingers 1. Hematoma formation is a common complication, and if it occurs proximal to the access site, it may indicate arterial perforation, usually of a side branch, which can lead to severe bleeding and potentially require surgical repair 1. Arterial spasm, thrombosis, or occlusion may also occur, potentially causing ischemia to the forearm and hand. Infection is possible, as with any invasive procedure, and vasovagal reactions can happen due to pain, leading to sudden drops in blood pressure and heart rate.
Some of the key complications associated with arterial blood draws from the brachial artery include:
- Hematoma formation, which can lead to compartment syndrome in severe cases
- Arterial spasm, thrombosis, or occlusion, potentially causing ischemia to the forearm and hand
- Injury to the median nerve, causing severe pain, numbness, and potential long-term motor dysfunction in the hand and fingers
- Infection, as with any invasive procedure
- Vasovagal reactions due to pain, leading to sudden drops in blood pressure and heart rate
The brachial artery is also more difficult to stabilize than other sites like the radial artery, increasing the risk of multiple puncture attempts, which can further increase the risk of complications 1. For these reasons, alternative sites, such as the radial artery at the wrist, are typically preferred for arterial sampling when needed, as they have better collateral circulation and fewer critical adjacent structures.
From the Research
Risks of Arterial Blood Draw to the Brachial Artery
The risks of an arterial blood draw to the brachial artery in the upper arm include:
- Hematoma formation 2, 3, 4, 5
- Thrombosis 2, 3
- Dissection 2
- Infection 2
- Pseudoaneurysm 2, 3
- Nerve injury 2, 6
- Reoperation 2
- Readmission 2
- Access site stenosis/occlusion 5
- Compression neuropathy 6
Factors Influencing Risk of Complications
The risk of complications after brachial access is influenced by several factors, including:
- Age 5
- Female gender 3, 5
- Sheath size 4, 5
- Use of anticoagulation 6
- Method of access (percutaneous vs. surgical cutdown) 2, 5
- Use of ultrasound guidance 4
Complication Rates
The complication rates for brachial artery access vary depending on the study and the method of access used. Reported complication rates include: