Chest
clinical investigations: Arterial Lines: Journal ArticleNonphysician Placement of Arterial Catheters: Experience With 500 Insertions
Section snippets
METHODS
Respiratory therapists, each with years of experience in arterial puncture, were instructed in the technique of arterial line placement. Each therapist was proetored by a critical care physician for a minimum of five insertions. After being judged competent, the therapist was certified to perform the arterial catheterization procedure. Femoral artery insertion also was performed by therapists once they had mastered radial artery insertion. Therapists were further proetored quarterly by a
RESULTS
From 1985 to 1993, 506 arterial catheters were placed in 483 patients. The insertion rate increased from 3 to 4 per month at onset to 9 to 14 per month at present. The patients represented a cross section of patients in a mixed medical-surgical and cardiac intensive care unit. All sepsis syndrome, ventilated, or otherwise critically ill patients received arterial lines as did most patients requiring Swan-Ganz catheterization. Duration of arterial catheter placement ranged from 1 to 20 days and
DISCUSSION
The study data show that specially trained respiratory therapists can insert arterial lines safely and efficiently.
The rate of superficial infection of 5 percent is within the 10 percent range found in prior studies.3 When evaluating patients with positive blood cultures, we found no cases of catheter-related bacteremia or sepsis. In some cases, however, positive blood cultures attributed to other sources and treated with the catheter in place may have resulted from infection of the arterial
ACKNOWLEDGMENT
We thank Howard Edelstein, M.D., for reviewing the manuscript. The medical editing department of Kaiser Foundation Research Institute provided editorial assistance.
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Impact - Improving patient access time: Arterial cannulation
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