(663) Association Between Arterial Catheter Securement and Catheter Displacement

Introduction: Arterial catheters are a common form of monitoring in the pediatric intensive care unit (PICU) but a common complication is accidental line displacement. Although arterial lines are frequently sutured to decrease the risk of displacement, it is unknown whether this practice reduces inadvertent removal. We aimed to determine the association of suturing as a securement method with the risk of displacement due to displacement.

Methods: We conducted a single site retrospective cohort study of arterial catheters placed by a member of the PICU team from December 2019 to April 2023. We excluded arterial lines placed by other hospitals or services. The reason for arterial line removal was dichotomized as end of therapy or dislodgement, determined by nursing documentation. A multivariate Cox proportional hazards regression model was used to determine the association of suture securement with arterial catheter survival time, adjusted for patient weight, continuous sedation at the time of placement, use of continuous neuromuscular blockade at time of placement, type of catheter, and training level of the proceduralist.

Results: Of 780 included arterial catheters, 618 were sutured (79.2%) and 162 were unsutured (20.8%). The median duration of arterial lines in situ was 124.3 hours. There were 263 (33.7%) that were displaced; the remaining 517 were maintained until the end of therapy. Suturing was associated with a lower risk of displacement (adjusted hazard ratio, 0.58; 95% CI 0.40-0.77) after adjusting for covariates. Use of continuous sedation at the time of placement was associated with a higher risk of displacement (adjusted hazard ratio 1.46; 95% CI 1.05-2.02). There was no association between displacement and training level of the proceduralist, type of catheter, or use of neuromuscular blockade at the time of placement.

Conclusions: We found an association between sutured arterial lines and decreased risk of arterial line displacement, even after adjusting for other factors. Sutures may prevent arterial catheter displacement, but further prospective studies are needed. An association between use of continuous sedation and catheter dislodgement was an unexpected finding that merits further investigation.