B54-43 Preventing Arterial Cannulation During Central Venous Catheter Insertion - A Quality Improvement Initiative Utilizing Manometry and Structured Education

Abstract Introduction Arterial cannulation remains a rare but serious complication of central venous catheter (CVC) placement, with an estimated incidence of 0.1- 1.0% in the absence of confirmatory testing. Literature suggests that manometry use offers up to 100% sensitivity method in detecting inadvertent arterial cannulation yet is underutilized. Following an inadvertent arterial cannulation that led to complications at our institution we initiated a quality improvement intervention to enhance procedural safety through incorporating pressure manometry and targeted resident education. Methods This quality improvement initiative was conducted in the Medical Intensive Care Unit at an academic medical center. CVC placement protocol was modified to mandate the use of pressure manometry for vessel verification in the workflow and amending the electronic procedure note template to capture relevant metrics. Concurrently incoming Internal Medicine Residents received orientation that included a structured lecture, practical demonstration, and a 10 question pre and post rotation survey. Residents self-reported comfort with 9 procedural domains using a 5-point Likert scale. Procedural data was prospectively collected from updated epic templates and included demographic details, technical metrics, operator experience, and complications. Results Among 51 residents, the mean knowledge score improved from 4.82 ±0.49 pre rotation to 6.53 ±0.41 post rotation, representing 35% relative increase. Post intervention surveys demonstrated increased procedural confidence across all domains, especially in manometry use, complication recognition, and anatomical localization. Prospective review of procedure log showed a reduction in arterial punctures compared to pre-intervention baseline. No cases of arterial cannulation requiring surgical intervention were reported post implementation period. Conclusion By integrating pressure manometry into CVC placement protocols, paired with targeted resident education, we observed marked improvement in patient safety, resident knowledge and procedural confidence. This scalable, sustainable intervention has immediate practical relevance for Medical Intensive Care teams and represents a transformative step in establishing a more reliable and safer vascular access technique. We therefore advocate for implementation of pressure manometry in additional Intensive Care Units, thereby establishing a new standard of care for CVC placement. This abstract is funded by: None