Comparison of Arterial Access Sites in an Oncologic ICU: Is Brachial Artery Catheterization a Safe Alternative?

Abstract

IntroductionContinuous invasive arterial blood pressure monitoring is the reference standard in the intensive care unit (ICU) for cardiovascular management. This study aimed to evaluate the safety of brachial arterial catheterization compared with radial and femoral approaches.MethodsA retrospective observational study of critically ill oncologic patients admitted to the ICU of Hospital SOLCA (Quito, Ecuador) between January 2021 and December 2023 was conducted. Data were extracted from the REDCap. Continuous variables were summarized as medians (IQR) and dichotomized at the median for regression analyses. Univariable logistic regression evaluated associations between clinical variables and catheter site (radial vs brachial). Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and statistical significance was defined as p < .05.ResultsA total of 305 arterial catheterizations were analyzed. Radial access was most frequently used (75.59%), followed by brachial (18.78%) and femoral (3.76%). In univariable analysis, admission priority III (OR 2.57, 95% CI 1.13-5.68; p = .02) and requiring two or more catheterization attempts (OR 11.50, 95% CI 4.81-29.20; p < .001) were significantly associated with catheter site. No vascular, infectious, or neurological complications were observed.ConclusionAdmission priority III and multiple attempts were significantly associated with catheter site selection. Brachial access demonstrated a safety profile comparable to radial and femoral sites, representing a valid alternative when radial cannulation is not feasible. Arterial catheterization in critically ill oncologic patients was safe, with very low complication rates. Prospective studies are warranted to confirm these findings.