Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr.

Hernn Henrquez Aravena

ORIGINAL ARTICLE

Behaviour of arterial lines of hospitalized

patients, in the ICU adult Hospital Doctor
Hernn Henrquez Aravena of Temuco Abner
Marcelo Castro Huaiquilaf 1. Gustavo Adolfo Araneda Gutirrez2.

Summary
Arterial
Monitoring:
The
intra-arterial
monitoring is performed by inserting a catheter
into an artery, generally the radial or femoral
artery.
General Objective: To determine behaviour of
arterial lines in patients with arterial pipe for a
period greater than 24 hours, who were
hospitalized in the Intensive Care Unit of the
Hospital HHA and which were channelled in
this unit or in the service of the flag during the
period from October 2005 to October 2006,
with regard to events such as: infection of the
insertion site (ISI) which for this study was
defined as: redness, induration, pain on
palpation, presence of pus. We also evaluated
the displacement, fracture and coagulation of
the arterial line that led to its withdrawal.
Material and Method: Prospective study
descriptive and analytical in which undertook a
follow-up to the arterial line until his retirement
by ISI, displacement, fracture, clottion or
censorship by the patients who remained two
channels for a period greater than 24 hours,
who were hospitalized in the Intensive Care
Unit of the Hospital Dr. Hernn Henrquez
Aravena (HHA) in Temuco, to which you
inserted the arterial line in this unit or in the
service of the flag during October 2005 to
October 2006.
Results: In this period were followed 466
arterial lines which were channelled in 364
users. Of these, 256 (54.9%) men and 210
(45.1%) women. The pathology of income
accounted for 172 (47.2%) medical, 115
(31.6%) surgery, 72 (19.7%) neurosurgical and
5 (1.5%) Other. The average age was 57.0 DS
17.7. The Apache average in the day of
pipeline was 18.7 DS 6.8. The time of

canalization average was 6.35 days DS 5.2. With

regard to the location of pipeline corresponded to:
radial 272 (58.6%), brachial 140 (30.1%), asked
30 (6.4%) and femoral 23 (4.9%). Only the type of
material used in the puncture was associated with
infection of the site of insertion, displacement and
coagulation.
Keywords: Arterial Pipeline, arterial line,
invasive arterial pressure, descriptive and
analytical study.

Introduction
Arterial monitoring: It is well known that most of
the patients hospitalized in the units of carestwo intensive culture are subjected to various
forms of invasion through intravascular
catheters, historically the measurement of
arterial invasive pressure begins in 1941 when
varinas cannula for the first time the aorta to
measure its pressure through a femoral
catheter introduced from a surgical exposure,
until 1947 do not have a suitable pressure
transducer to allow a clinical monitoring simple
but the measurement was carried out with
metallic systems so that you can not keep a
long time in the inside of the artery, which is
fixed in 1950 when Massa introduces plastic
catheters guided by a needle fedora Metal. In
1961 described the cannulation of the radial
artery by this method. And then applies the
Seldinger technique to cannulation of the
peripheral arteries, which was described in
1953, and are those that are currently used.
The intra-arterial monitoring is performed
by inserting a catheter into an artery,
usually the radial or femoral3,19,23,24.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Invasive arterial line pipe. Procedure with

aseptic technique that allows the control of
the arterial pressure continued, using a
system that is designed for the
measurement of the three parameters of the
blood pressure: systolic, diastolic and mean
arterial pressure (MAP)3,15,23,24.
The measurement of invasive arterial
pressure; it is a system that is designed
for the continuous measurement of the
three parameters of the blood pressure:
systolic, diastolic and mean arterial
pressure (MAP), performing continuous
appraisal of the arterial perfusion of the
main systems of the organism, in
addition this invasive arterial access is
useful for the control of patients with
acute respiratory insufficiency that
require frequent mind determinations of
the arterial gasometer, avoiding the
multipunciones and therefore decreasing
the stress of the patient. The most
common places used are, by order of
preference: the radial artery, brachial,
femoral and dorsal pedial. In 90% of
cases are used the radial artery and
femoral artery. The measurement of the
invasive arterial pressure offers several
advantages over non-invasive methods,
such as a greater precision in the
measurements (is currently considered
to be the gold standard of the
measurement systems of the PA),
especially in situations of hypotension,
arrhythmia or in cases of hypothermia,
etc. can be used in addition to the taking
of examinations.
The artery more channelled is the radial
artery because it possesses collateral
circulation in the direction of the hand, is
covered by the ulnar artery and the
palmar arch in the majority of the people,
with which there are other circulatory
contributions if the radial artery is
blocked by the placement of a catheter
(before cannulation should be evaluated
for the presence of collateral circulation
with the test of Allen)19.
In the peripheral arteries are used Teflon
catheters, mounted on the needle
(typically 20 G); in large arteries is used
the Seldinger technique (polyethylene
catheter).

Once channelled the artery with a teflon

proceeded to connect with the system of
pressure transducer. The transducer is placed
at the level of the right atrium of the patient and
there will be a calibrated at the level of the
atmosphere in this position. In those moments
will be displayed the wave of the blood pressure
of the patient in the monitor. The function of
transducer is twofold. On the one hand keeps
the system permeable, while also changes a
wave of hydrostatic pressure in an electronic
wave that the monitor interprets and amplified in
the screen. The system can be cleaned with a
greater flow of fluid by actuating an additional
valve of rubber that incorporates the transducer.
This system is permeable with a flask of
physiological serum of 250 cc to which you
added 1,250 IU of heparin, it is necessary to use
a device pressurized to 300 mmHg of pressure
to prevent the reflux of the arterial blood and this
pressure is released 3 cc per hour of
physiological saline more heparin. In the
literature describes the use and benefit of the
addition of units of heparin to the physiological
sera permeabilizar arterial lines, thus allowing
the permeability of these to avoid the
obstruction due to the formation of clots that
adhere to the Teflon5.
The pipeline has been related to arterial
complications, which have an incidence of
15% to 40%, among which the following
are highlighted: vasospasm, infections,
bacteraemia, arterial blockage etc.9,4,17,20.
The most important and the most common
are: bleeding, thrombosis, inflammation,
infection infiltration by air embolism,
paraesthesia and distal obstruction of the
arteries and ecchymosis9,17,22.
A) Thrombosis. Is the most common
mainly in the peripheral arteries remain
rare in the major arteries. It is more
frequent in women, probably due to the
small caliber of the arteries and the higher
frequency of vasospasm. Most of the times
recanalizan spontaneously in 3 weeks.
The severely symptomatic cases, who
come to need surgery, are less than 1%.
The treatment consists in the removal of
the catheter and, if it persists the clinic, the
use of thrombolytic or embolectomy. Its
frequency varies
,11,13,17between 5% and 25% to
.
the 4 days9

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

B) A cerebral embolism. It has been

demonstrated with radioisotopes the
possibility of retrograde flow to reach
the brain arteries. The factors that
favour are the position of the patient,
the infusion rate and the position of the
catheter. Prevention consists in the
careful management of the system and
of the connections and avoiding quick
infusions with syringes 9,11,13,17.
C) Infection. It is, because of its
implications, the most important globally.
Increases with the taking of samples on
repeated occasions and by different staff.
The most important predisposing factor is
the duration of catheterization and other
associated factors9-11,17.
D) Haemorrhages. Can be serious if you
inadvertently disconnects the system19.
We found two systematic reviews, which
analyse the complications of the arterial pipeline
by location they were published in 2002 and
involve the same work of these could be drawn:
- Radial Artery. In this systematic review
analyses - Ron 19.617 pipes of radial
artery9.17.
The
most common
complication associated with channelling
of radial artery was the temporary
occlusion, the incidence was found in the
ranges from 1.5% to 35%. The
Permanent occlusion presented an
incidence of 0.09%.
In relation to the sepsis was recorded an
incidence of
0.13%. With regard to the incidence of
local infection the incidence was 0.72%.
- Femoral Artery. In relation to the
femoral artery were analysed 3,899
pipes9.17. It can be removed that the
temporary
occlusion
reported
an
incidence of 1.45%. With regard to the
sepsis was presented an incidence of
0.44% and analyse local infections found
an incidence of 0.78%. The bleeding
recorded an incidence of 1.58%.
- Axillary artery. Of a total of 1.989
pipes analysed in this systematic review
the following was found9.17: permanent
ischemia in two patients with 0.20%,

formation of pseudoaneurisma in a patient

0.1% and sepsis in five patients with 0.51%.

When you analyse the published works that

compare the different locations of insertion:
Radial, femoral, brachial and requested. In
relation to the complications and in
particular those related to infection may
determine that there are no significant
statistical differences- mind7,9,11,17.
Of the jobs that considered the time of
pipeline as a factor of risk for the onset of
infection in all the works published is able
to establish that there was a relationship
and in most statistical significance was
found7,9,12,10,18,16,21.
To determine the severity of the patients the
severity score more validated in patients
of intensive is the APACHE II2,8,14,17.
The work analysed in one it was
determined the gravity as a risk factor this
being statistically significant while in
others it has been demonstrated29,30.
In relation of the infection in the local site
of insertion of arterial lines in relation to the
type of practitioner who performs the
pipeline, i.e. if the pipe was carried out by
a doctor or by another non-medical
professional, we find a job in the that was
able to determine that can be done by nonmedical professional but properly trained,
which determined that there are no
significant differences1.
In a theoretical way is associated with the
emergence of infection, pathologies, and
concomitant diseases such as: diabetes
mellitus and immunodeficiency. The
works
reviewed
were
inconclusive10,11,13,17.
When we analyse the complications
associated with the arterial pipeline we find
what follows: With regard to bleeding the
ranges of bleeding were 0.34% to
3.71%9.17.
In relation to the temporary occlusion (OT)
were analysed 4,991 arterial lines. The
ranges of OT were 2.8% to 25.9%. When
analysing the sum total of the work the
percentage obtained is of 4.92%9.17.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

To evaluate the occurrence of

hematoma (Table 3) in the arterial pipes
find seven works that did this analysis,
the total arterial lines considered by
these studies was 4,774, the ranges of
presentation of this complication was
0.28% to 17,79% and 5.44% is obtained
when considering the sum of all
studies9.17.
Pathogenesis of infection associated with
intravascular catheter according to the
bibliography revised infections associated with
catheters can be caused by the arrival of the
microorganisms to the bloodstream, occurs
primarily in two ways: by the outer surface of
the catheter, track extraluminal, or by the
interior of the catheter, track intraluminal, from
a connection or a fluid infusion contaminated.
Although it is less frequent, you can also
colonize the tip of the catheter from seeding
haematogenous, from a septic focus distant16.
- Skin and extraluminal progression: in
track extraluminal microorganisms move
through the outer surface of the catheter
from the insertion point in the skin until you get
to the tip. In the protein film that forms around
the tip of the catheter to the 48-72 hours of the
implementation
of
the
latter,
the
microorganisms multiply rapidly protected from
host defences and when they reach a critical
concentration pass into the bloodstream and
cause bacteraemia6. Maki and other authors
demonstrate that the colonization of the
skin and the progression of the
microorganisms by the outer surface of the
catheter is the most frequent source of
infection associated with catheter. The
microorganisms that access to the tip of the
catheter come, in most cases, the skin of
the patient, but can also have reached the
tip, through the hands of the health
personnel or inanimate objects11,13,24.
- Connection
and
endoluminal
progression: in a significant number of
cases the entrance door of the infection
is the contamination of the connection
between the infusion and the catheter to
be manipulated by the health personnel
during routine changes infusion system.
Since the connection bacteria migrate
through the interior of the catheter until
the tip, circumventing the defence
mechanisms of the guest and causing

IAC. After numerous studies has been able

to determine that the colonization of the
connection is at least the second cause in
frequency of IAC and is associated with
bacteraemia with greater frequency than
the colonization of the skin12,11,13,17.
- Contamination of the fluid to be infused:
currently, there are very few intrinsic
contamination of the infusion fluids at the
time of their manufacture, thanks to the
stringent control measures during the
industrial manufacture. Most often the
contamination of the fluid to be infused is
extrinsic, primarily by manipulation of their
components. Track pathogenic is the
endoluminal and connection is polluted in
most cases20.
- Haematogenous Seeding: contamination
of the external and internal surfaces of the tip
of the catheter may be caused by a sowing
haematogenous from a septic focus
distant11,13.

Justification of the study

Special features of the Adult Intensive Care
Unit of the Hospital Dr. HHA of Temuco.
Arterial lines are used for hemodynamic
monitoring and for sampling.
In the Unit, approximately 90% of arterial
lines are placed by the nurses.
There are two types of materials for the
pipeline: brnula arterial catheter and, with
a significant price differential between both.
There is a sufficient amount of arterial
lines for the study.

Problem
What is the behaviour of arterial lines in
patients with arterial pipe for a period greater
than 24 hours, hospitalized in the Intensive
Care Unit of the Hospital Dr. Hernn Henrquez
Aravena from the city of Temuco? Those who
were channelled into this unit or in the service
of the flag during the period from October 2005
to October 2006?.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

General Objective
Determine the behaviour of the artery
lines- les in patients with arterial pipe for
a period greater than 24 hours, who
were hospitalized in the Intensive Care
Unit of the Hospital Dr. Hernn
Henrquez Aravena (HHA) of Temuco.
Those who were channelled into this
unit or in the service of the flag during
the period from October 2005 to
October 2006, with regard to events
such as: ISI, displacement, fracture and
coagulation, which led to its withdrawal.

Specific Objectives
Relate the infections of the catheter
insertion site with: apache the day of
pipeline, sex, age, place of pipeline, type
of material used in the puncture,
professional who performed the pipeline,
number of punctures, anatomical
localization and the existence of
associated pathologies to ISI.
Determine if there are statistically
significant differences in the appearance
of ISI in arterial lines channelled by a
doctor or nurse.
Determine if there are statistically
significant differences between the
arterial line pipe with catheter or brnula
with regard to infection of the site of
insertion, displacement, fracture and
coagulation.

MATERIAL AND METHOD

Prospective, descriptive and analytical in that
there was a follow-up to the arterial line until
his retirement by ISI, displacement, fracture,
coagulation or censorship by the patients
who remained channelled for a period
greater than 24 hours, who were
hospitalized in the Intensive Care Unit of
the Hospital Dr. Hernn Henrquez
Aravena (HHA) of Temuco, which you
inserted the arterial line in this unit or in the
service of the flag during the period from
October 2005 to October 2006. To

determine statistical significance

established a requirement of 95%.

was

Dependent
- Infection of the site of insertion: For this
study was defined as: redness, induration,
pain on palpation, presence of pus.
- Displacement: Slide the arterial line from
the artery channelled by any cause.
- Coagulation: presence of blood clot that
prevents obtaining image of pressure curve in
the monitor.
- Fracture: injury of the material used for the
pipeline.
Definition
variables
variables

of the response
or
independent

The independent variables for this study

were: age, sex, pathology of admission,
APACHE II of income, practitioner who
performs the installation of the arterial line,
place of pipeline, presence of associated
pathologies, anatomical site of pipeline,
material used in the puncture and period of
pipeline.

Inclusion Criteria
Hospitalized patient in the Intensive Care Unit of the
Hospital HHA of Temuco greater of 15 years.
Arterial catheter stay longer than 24 hours.
Channelling of arterial catheter in the service of
the flag and ICU adult Hospital HHA of Temuco.
Patient channelled with arterial catheter
(Arteriofix, Certofix), and brnula (yelco, etc).
Only blood pipeline.

Exclusion criterion
Hospitalized patient in another service of the
Hospital with arterial catheter.
Patient with central venous catheter, catheter of
Swanz Ganz, peripheral venous catheter, etc.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Arterial pipe made on another service of

the Hospital or any other Hospital.
Arterial catheter stay of less than 12 hours.

When we analyse the type of material used

- oj for the pipeline are the following:
brnula

The universe is all patients with arterial

pipeline that were hospitalized in the
intensive care unit of the Hospital Dr.
adult HHA of Temuco during the period
October 2005 to October 2006.

335 (71.7%) and catheter 131 (28%). Of

total lines channelled 98 (21%) were
placed in patients with pathologies
associated with infection of the site of
insertion. To analyse the reason for
withdrawal of the arterial line were able to
determine
that
were
presented:
displacement in 74 (15.9%), fracture, 51
(10.9%), infection of the site of insertion in
36 (7.7%) and clotting in 30 (6.4%).

Displays

Statistical Inference

The sample of this study will shape the

patients hospitalized in the Intensive
Care Unit with arterial line placed in this
unit or in the service of the flag of the
Hospital Hernn Henrquez Aravena
those who remained inserted by a time
greater than 24 hours during the period
October 2005 to October 2006.

When performing statistical inference by nonparametric test log rang we were able to
establish that was not associated with the
occurrence of infection of the site of
insertion the age, gender, pathology of
admission, APACHE II of income,
professional who conducted the channelling
of the arterial line, place of pipeline and the
pathologies associated with ISI (Table 1).

Universe

Descriptive Analysis
During the period of study was followed
466 arterial lines which were channelled
in 364 users. Of these, 200 (54.9%) men
and 164 (45.1%) women. The pathology
of income accounted for 172 (47.2%)
medical, 115 (31.6%) surgery, 72
(19.7%) neurosurgical and 5 (1.5%)
Other. The average age was 57.0 DS
(17.7). The APACHE average in the day
of pipeline was 18.7 DS (6.8). The time
of canalization average was 6.35 days
DS (5.2). With regard to the location of
pipeline corresponded to: radial 272
(58.6%), brachial 140 (30.1%), asked 30
(6.4%) and femoral 23 (4.9%). In relation
to professional in charge of the
installation: Nurse 331 (71%) and doctor
135 (29%). In what it says respect to the
place of pipe is noted the following: ICU
adult 354 (76.0%), the flag 112 (24.0%).

With respect to age at first instance was

used with patients older than 65 years vs
minors under the age of 65 years but it
was not possible to make a comparison
by a problem of convergence that is why
we use the mean or average to make the
cut in the age. According to our analysis,
when we compare the anatomical sites of
pipe with the statistical test, reflected that
there was a statistically significant
difference (Figure 1). But to make Cox
regression was able to demonstrate that
this difference was related with the
material used in the puncture and not the
puncture site (Table 2).
When we compare the months of pipeline,
which were divided into public holidays and
not public holidays and did

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Table 1. Presence of ISI of arterial lines, according to age, sex, pathologies of admission, APACHE II OF
INCOME, professional who performed the installation, place of pipeline, pathologies associated with ISI,
USERS channelled in the adult ICU SERVICES
And the FLAG OF THE HOSPITAL DR. HHA OF TEMUCO, during the period from October 2005 to
October 2006
Variable

Comparison Variable

P Value

Age

Age <57 years vs age >57 years

0,4135

Sex
Pathology of Income
Apache II of Income
Professional who installs
Place of pipeline
Pathologies associated with ISI

Male vs female
Medical, surgical, neurosurgical
Apache II <20 vs APACHE II >20
Doctor vs nurse
Icu adult vs flag
Yes vs. No

0,9285
0,1484
0,6528
0,2296
0,2365
0,5951

Figure 1. Presence of ISI of arterial lines, according to anatomic site of puncture of users channelled into the services
of ICU adult and flag of the Hospital Dr. HHA of Temuco.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Table 2. COX regression, presence of ISI of arterial lines, according to anatomic site of
pipeline
Variable Beam. Ratio z P>|z| [95% Conf. Interval]
Material
Age
Sex
Location

3.58
0.62
0.88
1.31

2.84
-1,34
-0.35
0.99

Statistical inference were able to determine

that the difference was statistically significant
and was reflected in the graph that in the
months holidays had been presented fewer
infections (Figure 2). When performing Cox
regression was able to establish that the
difference was due to the material used in
these periods (Table 3).
It was established that only existed difference
statistical significant when comparing the
automatically type of material used in the
puncture, and it was demonstrated that there
was greater infection in patients with brnula
channelled, which is clearly shown in the graph
of survival (Figure 3). When controlling for
other variables are notes that this difference
must be specific - mind the material used and
were able to determine that the risk of ISI is 3
times greater in patients with brnulas
channelled- two if we compare them with the
channelled with catheter (Table 4).
With regard to the coagulation of the
arterial line were able to determine that
was related only to the type of material
used and the brnula presented more
coagulation which the catheter which is
clearly seen in the chart

0.004
0.180
0.719
0,323

1,487
0.31
0.448
0.764

8.64
1.24
1.73
2.25

Survival (Figure 4), and this difference was

statistically significant- ing P= 0,0072
respectively. The risk associated with the
use of brnula is 4 times higher when
compared with catheter. By Cox regression
was able to establish that this difference
was only due to the type of material used in
the puncture, since this difference remains
statistics - mind significant and was not
associated with the other control variables
(Table 5).
In relation to the movement of the
arterial line is also associated only with
the type of material used - OJ and this
is clearly seen in the chart of survival
(Figure 5), this difference was
statistically significant depending on the
test used P= 0.0007. When controlling
for the other variables This difference is
maintained (Table 6).
Conclusions

The revision of the analysis of the

results can be ripped off several
conclusions from those that highlights

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Table 3. COX regression, presence of ISI of arterial lines, according to period of pipeline
Variables

Beam. Ratio.

Material
Age
Sex
Months

3,445
0,715
0,928
0,537

2.7
-0,92
8
-0.21
-1,69

P>|z
|
0.00
0,35
6
6
0,82
8
0.09
1

[95% Conf.

Interval]

1.438
0.305
0,471
0.261

8,255
1,176
1,825
1.105

Figure 3. Presence of ISI of arterial lines, according to material used in the puncture of users channeled in the services
of ICU adult and flag of the Hospital Dr. HHA of Temuco.

Table 4. COX regression, presence of ISI of arterial lines, according to MATERIAL USED
IN THE PUNCTURE

Variables

Beam. Ratio

P>|z|

[95% Conf.

Interval]

Material
Age
Sex
Professional

3.453
0.599
0,980
0.669

2.77
-1.48
-0.05
-0.9l

0.006
0,137
0,954
0.365

1,435
0.305
0.495
0.322

8.305
1,176
1,940
1,517

Figure 4. Presence of coagulation, according to material used in the puncture of users channeled in the services of
ICU adult and flag of the Hospital Dr. HHA of Temuco.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Table 5. COX regression, presence of coagulation of arterial lines, according to MATERIAL

USED IN THE PUNCTURE
Beam variables. Ratio. z P>|z| [95% Conf. Interval]
Material
Age
Sex
Professional

4,230
1.158
1,042
0.655

2.35
0.38
0.11
-1,08

0.019
0.700
0,911
0.282

1.27
0.54
0.49
0.30

14,068
2442
2,180
1,415

Table 6. COX regression, PRESENCE OF DISPLACEMENT OF ARTERIAL LINES, according to

MATERIAL USED IN THE PUNCTURE
Beam variables. Ratio z P>|z| [95% Conf. Interval]
Material
Age
Location
Sex
Professional

2,916
0,757
0,927
0,899
1,550

3.30
-1,16
-0,43
-0,43
1.43

0.001
0.245
0,671
0,662
0.153

1,545
0,474
0,657
0,558
0.849

5.504
1,209
1,310
1448
2,829

- With regard to the appearance of ISI

existed only relationship with the type of
material used in the puncture.

- The type of material was related to

the presence of ISI, displacement and
coagulation.

- It was possible to establish that there

was no statistically significant difference
when the arterial pipeline was carried out by
a doctor or a nurse1,3,5,8.

- The age and sex did not behave as

confounding or switches of effect.
- Under the same conditions of this job
if it can be concluded inference and can
be
done
recommendations.

Behavior of arterial lines of patients hospitalized in ICU adult Hospital Dr. Hernn Henrquez Aravena

Generalizable to do this it is necessary to

increase the sample.

References

Comment

1. Gronbeck C, Miller E. Nonphysician Placement of arterial

catheter. Experience with 500 insertions. Chest 1993, 104:
1716-17.

In the light of the results, both in the tables

as in the graphics could be displayed with
clarity in our descriptive analysis that the
highest percentage of arterial lines were
channelled in the radial artery, which
correlates with the published studies, since
it is recommended by the collateral
circulation which it holds. Followed by the
brachial artery; what is different when
compared with the published studies in
which dominates the femoral artery as
second puncture site3,5,8.
With regard to statistical inference could be
established that only the type of material
used in the puncture was related to the
onset of infection of the site of insertion,
displacement, coagulation.
With regard to the studies reviewed none
felt the type of material used in the
independent as a variable puncture and this
study shows that is relevant 1,3-5,8,9 .
It is reassuring as a nurse to determine
through this study that there were no
differences in relation to the emergence of
ISI when the arterial line is channelled by a
professional doctor or nurse which is related
with the studies reviewed.
I believe that it is necessary to perform a job
multicentre
study,
maintaining
the
methodology of this study for
Increase the sample; with the intention of
obtaining results that are generalizable.

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