Comparison of the Incidence of Arterial Pressure Line Insufficiency Between Polyethylene and Polyurethane Catheters in the ICU: A Randomized Study.

Abstract

Objectives: Continuous arterial pressure monitoring is crucial for critically ill patients. However, the impact of catheter type on arterial line insufficiency remains unexamined.

Design: Double-blinded, superiority, randomized controlled trial.

Setting: A cardiovascular center in Japan.

Patients: Adult patients scheduled for elective cardiovascular surgery and postoperative admission to the ICU.

Interventions: Patients were randomly assigned either polyethylene or polyurethane catheters.

Measurements and main results: The outcome of interest was arterial line insufficiency, defined by one or more of the following four criteria: flattened or overdamped blood pressure waveform, sluggish free backflow of blood (> 2 s) when the stopcock was opened to the atmosphere, inability to draw blood from the arterial line, and inability to flush the catheter. The frequency of arterial line insufficiency was observed at the first noon after ICU admission. An interim analysis using the chi-square test was performed after half of the participants were enrolled, with early termination if p value of less than 0.005 based on the O'Brien-Fleming method. Interim analysis of 132 patients revealed significant differences in primary outcomes, leading to early termination of the trial. Arterial line insufficiency occurred in four of 69 patients (5.8%) with polyethylene catheters and 18 of 63 patients (28.6%) with polyurethane catheters (relative risk, 0.15; 95% CI, 0.05-0.48; p = 0.001).

Conclusions: This study demonstrated a lower occurrence rate of arterial line insufficiency with polyethylene arterial catheters than polyurethane catheters.