Feasibility and safety analysis of distal radial arterial catheterization for arterial pressure monitoring in ICU.

Abstract

Objective: To evaluate the feasibility and safety of distal radial artery (DRA) catheterization compared to conventional radial artery (CRA) catheterization for invasive arterial pressure monitoring in intensive care unit (ICU) patients.

Methods: This single-center, prospective, randomized controlled study enrolled 197 ICU patients requiring invasive arterial pressure monitoring between May 2024 and March 2025. Patients were randomly assigned to either the DRA group (n = 99) or CRA group (n = 98). Primary outcome was first-attempt puncture success rate. Secondary outcomes included final success rate, catheterization time, compression time for hemostasis, abnormal waveform frequency, unplanned removal rate, and complications.

Results: The DRA group demonstrated significantly lower first-attempt puncture success rates compared to the CRA group (68.69% vs. 82.65%, P = 0.022). With ultrasound assistance, final success rates were comparable between groups (98.99% vs. 97.96%, P = 0.993). Total catheterization time (133.61 ± 35.82s vs. 126.50 ± 36.99s, P = 0.175) and abnormal waveform frequency were similar between groups. The DRA group exhibited significantly shorter hemostasis times (224.45 ± 55.25s vs. 417.56 ± 71.32s, P < 0.001). Both groups had low complication rates with no statistically significant differences (1.01% vs. 3.06%, P = 0.621).

Conclusion: Despite lower first-attempt success rates, DRA catheterization provides equivalent monitoring stability to CRA with significantly reduced hemostasis time and comparable safety profiles. DRA represents a viable alternative for invasive arterial pressure monitoring in ICU patients, particularly those requiring rapid hemostasis, preservation of forearm radial artery integrity, and patients in special positioning.