Chest
Volume 104, Issue 6, December 1993, Pages 1716-1717
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clinical investigations: Arterial Lines: Journal Article
Nonphysician Placement of Arterial Catheters: Experience With 500 Insertions

https://doi.org/10.1378/chest.104.6.1716Get rights and content

To improve availability of arterial line placement, we developed a nonphysician protocol for respiratory therapists to insert arterial catheters. In our experience with more than 500 catheter insertions, in which placement lasted from I to 20 days, superficial infection occurred in 5 percent of patients and a major complication occurred in only 1 patient. These results show that specially trained nonphysician personnel can insert arterial catheters safely when following a protocol. Similar reallocation of existing resources should increase patient care while decreasing patient care cost in most settings.

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.

REFERENCES (4)

There are more references available in the full text version of this article.

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