From the Guidelines
Arterial lines should be performed as a sterile procedure to minimize the risk of catheter-related bloodstream infections and local site infections. The most recent and highest quality study, published in 2025, recommends adopting maximum sterile barrier precautions during central line insertion, which includes arterial lines, to reduce the risk of infections 1. This study suggests that employing maximum sterile barrier precautions, such as wearing a mask, cap, sterile gown, and sterile gloves, and covering the patient with a large sterile drape, can significantly reduce the risk of catheter-related bloodstream infections.
When placing arterial lines, full sterile technique should be used, including:
- Sterile gloves
- Mask
- Cap
- Sterile drapes
- Chlorhexidine skin preparation The operator should perform a thorough hand scrub before the procedure, and the insertion site should be cleaned with 2% chlorhexidine in 70% alcohol solution and allowed to dry completely before insertion. Local anesthesia with 1-2% lidocaine should be administered prior to cannulation to minimize patient discomfort. Common insertion sites include the radial, femoral, brachial, axillary, dorsalis pedis, and ulnar arteries, with the radial artery being the most frequently used due to its accessibility and collateral circulation.
Using sterile technique for arterial line placement is crucial, as evidence shows that arterial catheters can cause significant infections with similar pathogens to central venous catheters, and should therefore be treated with the same level of sterile precaution 1. Although the provided guidelines primarily focus on central venous catheters, the principles of sterile technique can be applied to arterial line placement to minimize the risk of infections. The 2025 study provides the most recent and highest quality evidence, and its recommendations should be prioritized in clinical practice 1.
From the Research
Arterial Line Management
- The use of arterial lines can pose a risk to patient safety, with the potential for infection and other complications 2.
- Studies have shown that the implementation of safe arterial line management practices, such as the use of sterile technique, can help to reduce the risk of infection 3.
Sterile Procedure
- There is evidence to suggest that arterial lines should be inserted and managed using sterile technique to minimize the risk of infection 3.
- The use of barrier precautions, cutaneous antisepsis, and insertion site selection can help to reduce the risk of arterial catheter-related bloodstream infections 3.
Infection Prevention
- The Centers for Disease Control and Prevention (CDC) recommend the use of sterile technique and other infection prevention measures to reduce the risk of arterial catheter-related bloodstream infections 3.
- Studies have shown that the use of antibiotic lock solutions, such as cefazolin and gentamicin, can help to prevent catheter-related bacteremia in patients undergoing hemodialysis 4.
Clinical Practice
- Clinical practice guidelines recommend the use of sterile technique and other infection prevention measures to reduce the risk of arterial catheter-related bloodstream infections 3.
- Further research is needed to update current clinical practice guidelines and to reduce the risk of arterial catheter-related infections 3.