Design and Develop Arterial Line Wrist Board For Critically Ill Patients: A Delphi Study

Abstract

Radial arterial cannulation is routinely performed in critically ill patients for continuous invasive blood pressure monitoring and arterial blood gas analysis. Inadequate wrist positioning during catheter insertion and maintenance may contribute to catheter-related complications, waveform distortion, inaccurate pressure measurements, and patient discomfort. Despite its clinical importance, a standardized wrist support device specifically designed for arterial line stabilization remains unavailable in many healthcare settings.

Objective: To design and develop a standardized arterial line wrist board for critically ill patients using Delphi technique and evaluate its effectiveness in reducing position-related complications.

Methods: A quantitative research design employing the Delphi technique was conducted. An expert panel participated in iterative Delphi rounds to develop and validate the wrist board. The finalized device was evaluated by comparing the incidence of position-related complications before and after implementation. Descriptive and inferential statistics, including the paired t-test, were used to analyse the data.

Results: Implementation of the arterial line wrist board resulted in a substantial reduction in position-related complications. Disturbed arterial waveforms decreased from 94.3% to 15.7%, inaccurate blood pressure measurements from 92.9% to 12.9%, hematoma from 91.4% to 18.6%, and infection from 74.3% to 25.7%. The mean complication score significantly decreased from 7.97 ± 1.04 before implementation to 2.20 ± 1.46 after implementation (mean difference = 5.77). Statistical analysis demonstrated a highly significant improvement following implementation (t = 30.03, p < 0.001).

Conclusion: The standardized arterial line wrist board developed through the Delphi technique was effective in reducing position-related complications associated with radial arterial catheterization. Its implementation may improve arterial line stability, enhance the accuracy of invasive hemodynamic monitoring, and promote safer nursing care for critically ill patients.