Distal versus conventional radial artery catheterization for hemodynamic monitoring in intensive care setting: a randomized, controlled, non-inferiority trial.

Background: Arterial catheterization is fundamental for hemodynamic monitoring in critically ill patients, yet instability and loss of arterial pressure waveform remain clinically significant issues. The distal radial artery (dRA) approach has been proposed as a potential alternative to the conventional radial artery (RA) approach. This is the first randomized clinical trial to assess the comparative efficacy and reliability of dRA versus RA catheterization by examining first-attempt success rates and the stability of arterial pressure waveforms in critically ill ICU patients.

Methods: This randomized controlled trial enrolled 200 critically ill patients requiring arterial catheterization, assigning them to either dRA (n = 100) or conventional RA (n = 100) groups. All procedures utilized a standard 20-gauge polyurethane peripheral intravenous catheter. Co-primary outcomes included first-attempt success rate and frequency of arterial pressure waveform loss during the initial 72-h period. Secondary outcomes included catheterization time, complications during insertion and management, hemostasis time, and catheter duration. Bonferroni correction was applied for multiple testing (α = 0.025).

Results: First-attempt success rates were comparable between dRA and RA groups (86% vs. 84%, P = 0.688). The dRA group experienced significantly fewer arterial pressure waveform losses across all three days (Day 1: 1.0 [0.0, 2.0] vs. 2.0 [1.0, 2.0]; Day 2: 1.0 [0.0, 1.0] vs. 2.0 [1.0, 2.0]; Day 3: 0.0 [0.0, 1.0] vs. 1.0 [1.0, 2.0]; all P < 0.001). Both groups achieved 100% procedural success with no site crossovers. Arterial catheterization time was longer in the dRA group (P < 0.001). Complication rates during catheterization, management, and after removal were similar between groups. Hemostasis time was significantly shorter in the dRA group (2.6 ± 1.5 min vs. 4.2 ± 0.9 min, P < 0.001). Catheter duration was similar between groups (76.6 ± 16.7 vs. 77.4 ± 16.4 h, P = 0.724).

Conclusions: While first-attempt success rates were similar, the dRA approach offered greater arterial pressure waveform stability and shorter hemostasis time than the conventional RA approach, without increasing complications. Thus, dRA may be a preferable option for arterial catheterization in critically ill patients.

Trial registration: This study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2400086284, registration date: 27/06/2024).