Complications associated with the insertion site of arterial catheters in intensive care: A propensity score-matching analysis

Objectives To identify complications associated with insertion, use, and removal of radial and brachial arterial catheter in two adult ICUs in Bogotá, Colombia, using a comparative cohort design with propensity score matching. Methods A retrospective cohort study was conducted in two adult ICUs. Adult patients who underwent ultrasound-guided arterial catheter insertion between January and December 2024 were included. The exposure was catheter insertion site, classified as radial or brachial. The primary outcome was the occurrence of at least one device-related complication during insertion, maintenance, or removal. Secondary outcomes included complications, procedural variables, and ICU length of stay. To reduce confounding, 1:1 propensity score matching was applied; covariate balance was assessed using standardized mean differences. Post-matching binary outcomes were analyzed using generalized estimating equations (GEE) with robust standard errors and matched-pair clustering. Results A total of 995 patients were included: 496 in the radial group and 499 in the brachial group. After matching, 842 patients were analyzed, with 421 patients in each group and covariate balance (SMD < 0.1). Brachial catheterization was associated with lower odds of at least one catheter-related complication (OR 0.61, 95% CI 0.44–0.86; p = 0.005). Post-insertion hematoma was associated with brachial access after multivariable GEE adjustment (aOR 4.11, 95% CI 1.49–11.31; p = 0.006), whereas brachial access was associated with lower odds of vasospasm (aOR 0.35, 95% CI 0.22–0.55; p < 0.001). No significant differences were observed in other complications or ICU length of stay. Conclusions In critically ill adults, brachial arterial catheter insertion was associated with fewer complications, although it showed a higher risk of post-insertion hematoma. Radial insertion was associated with increased vasospasm. Implications for clinical practice These findings support individualized selection of arterial catheter insertion site according to clinical profile and complication risk.