The prevalence and use of arterial catheters in adult intensive care units: an Australian and New Zealand point prevalence study

Background: Arterial catheters (ACs) are commonly used in intensive care units (ICUs) for monitoring and blood sampling. Optimising AC care requires a better understanding of current use and practices. Objective: The objective of this study was to determine the prevalence of AC use in ICU patients and describe current clinical practices. Methods: A prospective, multicentre, point prevalence study of patients aged ≥16 years was conducted across Australian and New Zealand ICUs as part of The George Institute for Global Health and Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program. Main outcome measure: The primary outcome was AC prevalence. Results: Of 924 patients from 59 ICUs, 68.2% had ACs, primarily in the radial artery (87.3%) with an open transducer set (65.7%). Most hospitals were metropolitan (88.1%) and publicly funded (84.7%). Patients had a mean age of 60.6 years (standard deviation: 16.4), 57.5% were male, and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17.7 (standard deviation: 7.4). Mechanical ventilation was used for 39.8% of patients, and 34.3% received vasopressors. Most (93.0%) were first-time ICU admissions, mainly from emergency departments (34.7%) or operating theatres (31.1%). The presence of an AC was associated with a slightly higher illness severity score, as shown by APACHE II (Cohens d: 0.34; 95% confidence interval [CI]: 0.20–0.48), and a modest increase in ICU length of stay (Cliff's Delta: 0.19; 95% CI: 0.11–0.27), higher odds of mechanical ventilation (odds ratio: 5.13; 95% CI 3.64–7.24), and vasopressor use (odds ratio: 7.70; 95% CI: 5.09–11.64). Management practice varied, with dressing changes occurring weekly (36.0%), every 4 days (20.0%), or as clinically needed (20.0%). AC removal was mostly clinically indicated (62.0%), with 20% of ACs removed at time-based intervals. Conclusion: The high prevalence of AC use in ICUs highlights the need for improved evidence-based guidance for practice, including indications for use, maintenance practice, and removal.