(1372) A Snap in the System: A Case of Spontaneous Radial Arterial Line Fracture

Introduction: Arterial lines are commonly utilized in critical patients within intensive care units, emergency departments, and operating rooms allowing for the monitoring of hemodynamics. Complications of arterial line placement have been reported to be as high as 26%, including occlusion, accidental dislodgment, infection, and pseudoaneurysm. The radial artery is the most common access site due to reported and observed lower complication rates at this site. We present a case of arterial line catheter fracture following a single attempt at placement of a radial arterial line.

Description: A 74-year-old man with stage IV gastric adenocarcinoma presented to the emergency department with progressive epigastric pain and nonbloody emesis. He rapidly decompensated in the ED requiring the placement of a central venous catheter and initiation of norepinephrine and vasopressin to achieve MAP 65. Abdominal CT and RUQ-US demonstrated acalculous cholecystitis. As his vasopressor use escalated, a radial arterial line was placed by palpation of radial pulse using a 20g (Braun; Introcan Safety®) angio-catheter. After a single attempt, the angiocatheter fractured resulting in a retained 2.5 cm fragment within the patient. Point of care ultrasound showed the retained fragment located superficial to, and outside of, the radial artery. Vascular surgery recommended against immediate intervention in the setting of an extra-arterial foreign body given the patient’s critical illness and multiple medical comorbidities. He underwent a percutaneous cholecystostomy tube placement and subsequent ERCP. His hemodynamics improved and vasopressors were titrated off. He transferred out of the ICU on hospital day 5. Vascular surgery recommended aspirin therapy, and that the catheter remnant be left in situ. The patient recovered to baseline and was discharged to a skilled nursing care facility.

Discussion: Arterial catheter fracture is a rare, but recognized, complication of arterial line placement. When a fracture does occur, a multidisciplinary approach is essential to manage the complications effectively. This case contributes to the growing body of knowledge on arterial line complications and highlights the need for ongoing vigilance and adherence to best practices in arterial catheterization.