On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management

Abstract

Background: COVID-19 patients require frequent arterial blood gas analysis for the assessment of oxygenation status. Objective: The main objective of this research is to describe a dedicated protocol developed to standardize the insertion and management of peripheral Arterial Catheters (AC) for on-demand use, in the Emergency Department of “Maggiore” Hospital (Lodi, Italy). This strategy represents a valid alternative to repeated arterial punctures outside the intensive care unit. Methods: The crucial points of the protocol were defined: vessel selection criteria, device used, technique of insertion, choice of securement and dressing device, and procedures had been created for correct management. Results: During April and December 2020, 50 AC were inserted, two dislocations and one malfunction were observed. No major complications (Catheter Related Bloodstream Infection, thrombosis, bleeding, pseudoaneurysms, hematoma, artery occlusion - even temporary - and skin irritation) were observed. Conclusions: To the authors knowledge, this is the first article describing the insertion and management of ACs for on-demand utilization outside the intensive care unit. The safe and effective use of this technique could be clinically relevant in patients requiring multiple ABG without need of invasive monitoring; it also allows the reduction of both artery sticks and workload of health care providers. However, clinical studies are needed to confirm the validity of the proposed treatment, especially the use of the most appropriate securement system and the most effective solution for locking catheters.