Duration of Radial Arterial Line Placement
Radial arterial catheters should not remain in the same site for longer than 48 to 72 hours and must be changed or removed as soon as they are no longer clinically necessary. 1
Evidence-Based Time Limits
The most authoritative guideline on this topic comes from the American College of Cardiology/American Heart Association, which explicitly states that intra-arterial catheters generally should not remain in the same arterial site for prolonged periods—specifically no longer than 48 to 72 hours without being changed—due to the risk of arterial thrombosis and infection. 1 This recommendation applies to radial artery catheters placed with small catheters, which are noted as the safest method for long-term arterial pressure monitoring. 1
Critical Distinction for Emergency Placements
Large artery catheters (brachial or femoral) placed without a sheath during an emergency should not be left in place for more than 6 hours. 1 This shorter duration reflects the higher risk profile of these access sites and emergency placement conditions.
Supporting Research Evidence
A prospective observational study of 134 ICU patients with radial artery cannulation demonstrated that patients were safely cannulated for an average of 13.3 ± 4.0 days, with catheter-related infection occurring in only 4 cases (3%). 2 However, this study also found that 19% of patients developed complete arterial thrombosis with vessel obstruction, and 57% had partial thrombosis, despite no clinical signs of ischemia. 2 This underscores that while longer durations may be technically feasible, the guideline-recommended 48-72 hour limit prioritizes safety by minimizing thrombotic and infectious complications.
Clinical Monitoring Requirements
The arterial circulation distal to the catheterization site must be carefully and periodically examined for evidence of tissue ischemia throughout the duration of catheter placement. 1 This surveillance is essential regardless of planned catheter duration, as complications can develop at any time.
Special Population Considerations
In patients with systemic sclerosis (scleroderma), radial arterial line placement carries exceptionally high risk, with case series documenting major ischemic events including digital gangrene, hand auto-amputation, and below-elbow amputation. 3 In these patients, alternative monitoring strategies should be strongly considered, and if radial access is unavoidable, the shortest possible duration is critical.
Practical Implementation
- Remove the arterial line immediately when hemodynamic monitoring is no longer clinically indicated 1
- If continued monitoring beyond 72 hours is essential, change the catheter to a new site rather than leaving the original catheter in place 1
- Never extend catheter duration simply for convenience—the risks of thrombosis and infection increase with time 1
- Document daily the ongoing clinical necessity for arterial monitoring to prompt timely removal 1