Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Abstract

Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia. In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). No patient had catheter-related infection in the intervention group (an estimated 12776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.