The impact of A Standardized Protocol for placement of Indwelling Arterial Catheters

Objective To define the indications for placement of indwelling arterial catheters (IACs) in a medical intensive care unit, restrict placement to these indications, and assess the effect of this restriction on patient outcomes and laboratory utilization as a surrogate for cost. Design Prospective study. Setting Teaching hospital tertiary care medical intensive care unit. Patients Data were collected from 292 consecutive admissions from the Medical University of South Carolina (Charleston, South Carolina) Medical Intensive Care Unit. INTERVENTIONS: Indwelling arterial catheter placement was restricted to 4 indications identified in the literature. The mean number of arterial blood gases per admission, ICU length of stay, and ICU and hospital mortality were compared prior to and after IAC restriction. MEASUREMENTS AND MAIN Results Four indications for IAC placement were identified in the literature: (1) hypotension requiring vaso- pressor medications; (2) hypertensive emergency requiring rapidly-acting intravenous antihyper- tensives; (3) situations where blood pressure must be controlled within narrow limits (eg, controlled hypotension); (4) greater than 5 episodes of phlebotomy per day. Patient demographics, length of ICU stay, and ICU and hospital mortality were similar between control and IAC restricted groups. The number of IACs placed was significantly (p = 0.004) reduced from 39 in 133 control group admissions to 17 in 124 IAC restricted admissions. The mean number of arterial blood gases per admission was 7.0 in the control group and 5.6 in the IAC restricted group (p = 0.23). Conclusions When IACs are restricted to published indications, the number placed is significantly reduced. The presence of an IAC alone does not influence arterial blood gas utilization. Critically ill patients who do not meet criteria for IAC placement can be safely managed without this technology. [Respir Care 1999;44(10):1193-1197]