Feasibility and safety analysis of distal radial arterial catheterization for arterial pressure monitoring in ICU.

OBJECTIVE

To evaluate the feasibility and safety of distal radial artery (DRA) catheterization compared to conventional radial artery (CRA) catheterization for invasive arterial pressure monitoring in intensive care unit (ICU) patients.

METHODS

This single-center, prospective, randomized controlled study enrolled 197 ICU patients requiring invasive arterial pressure monitoring between May 2024 and March 2025. Patients were randomly assigned to either the DRA group (n = 99) or CRA group (n = 98). Primary outcome was first-attempt puncture success rate. Secondary outcomes included final success rate, catheterization time, compression time for hemostasis, abnormal waveform frequency, unplanned removal rate, and complications.

RESULTS

The DRA group demonstrated significantly lower first-attempt puncture success rates compared to the CRA group (68.69% vs. 82.65%, P = 0.022). With ultrasound assistance, final success rates were comparable between groups (98.99% vs. 97.96%, P = 0.993). Total catheterization time (133.61 ± 35.82s vs. 126.50 ± 36.99s, P = 0.175) and abnormal waveform frequency were similar between groups. The DRA group exhibited significantly shorter hemostasis times (224.45 ± 55.25s vs. 417.56 ± 71.32s, P < 0.001). Both groups had low complication rates with no statistically significant differences (1.01% vs. 3.06%, P = 0.621).

CONCLUSION

Despite lower first-attempt success rates, DRA catheterization provides equivalent monitoring stability to CRA with significantly reduced hemostasis time and comparable safety profiles. DRA represents a viable alternative for invasive arterial pressure monitoring in ICU patients, particularly those requiring rapid hemostasis, preservation of forearm radial artery integrity, and patients in special positioning.