Distal Radial Artery Approach for Invasive Blood Pressure Monitoring in Intensive Cardiac Care Unit.

Area of Science:

• Cardiology
• Vascular Access
• Critical Care Medicine

Background:

• The distal radial artery (dRA) is an emerging vascular access site in interventional cardiology.
• Current practices often utilize the forearm radial artery (fRA) for invasive blood pressure monitoring.

Purpose of the Study:

• To evaluate the distal radial artery (dRA) as a viable alternative to the forearm radial artery (fRA) for invasive blood pressure monitoring.
• To assess the noninferiority of dRA compared to fRA in terms of catheterization success rates within an Intensive Cardiac Care Unit (ICCU).

Main Methods:

• A single-center, randomized, noninferiority trial involving 250 ICCU patients requiring invasive blood pressure monitoring.
• Patients were randomized (1:1) to either dRA or fRA access.
• Primary endpoint: final catheterization success rate. Secondary endpoints: first attempt success, catheterization time, pain, and complication incidence.

Main Results:

• Final catheterization success rates were noninferior for dRA (95.2%) versus fRA (96.8%) (p <0.001).
• First attempt success rates were lower for dRA (59.2%) compared to fRA (70.4%) (p = 0.12).
• Entry-site complications were significantly reduced with dRA (6.7%) vs fRA (17.4%) (p = 0.013), primarily due to decreased hematoma incidence (0.8% vs 6.6%; p = 0.020).

Conclusions:

• Distal radial artery access is noninferior to forearm radial artery access for invasive blood pressure monitoring in ICCU patients.
• dRA access demonstrates a significant reduction in entry-site complications, particularly hematomas.
• The dRA presents a promising alternative vascular access site in critical cardiac care settings.