Arterial Line Placement and Complications in Community ICUs: Site Selection, Ultrasound Guidance, and Infection Risk

Ufuoma Olori

Hospital Medicine and Critical Care, Iberia Medical Center, New Iberia, Louisiana 70560, USA.

Abstract

Peripheral arterial catheters are among the most commonly placed invasive devices in intensive care, valued for continuous blood pressure measurement and convenient blood sampling, yet their routine use has rarely been questioned. This question carries particular weight in community hospitals, where a large share of critically ill adults is treated by smaller teams with variable access to intensivists, ultrasound equipment, and infection prevention resources. This narrative review synthesizes the clinical literature and practice guidelines on the indications, insertion site selection, ultrasound guidance, mechanical complications, and infection risk of arterial catheters, and interprets that evidence through the operational realities of community intensive care units. The review shows that the long-held assumption that every patient with shock needs an arterial line is no longer well supported, since many such patients can be managed safely with noninvasive monitoring while avoiding bleeding and other insertion-related harm. When an arterial catheter is genuinely required, the radial artery remains the most balanced choice, offering reliable insertion, acceptable durability, and the lowest infection risk, whereas the femoral artery is better reserved for emergencies or failed radial access because it carries greater bleeding and infectious risk. Ultrasound guidance emerges as a practical way to improve first-attempt success and catheter longevity, particularly in patients with shock, obesity, or edema, without increasing infection, provided operators receive structured training and maintain competence. The review also highlights that arterial catheter infections are considerably more common than clinicians often assume, occurring at rates close to those of short-term central venous catheters, yet they fall outside routine surveillance and therefore remain largely unrecognized. Taken together, these findings suggest that community ICUs can achieve meaningful safety gains not through new technology but through consistent practice: deliberate indication review, radial-first site selection, routine ultrasound use, central-line-level asepsis and site care, daily assessment of continued need, and local tracking of catheter-related infections, supported by workforce planning and organizational commitment.

Keywords: Arterial catheter; Arterial line; Community hospital; Intensive care unit; Ultrasound guidance; Radial artery; Femoral artery; Catheter-related bloodstream infection; Shock; Noninvasive blood pressure monitoring

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