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Central Venous Pressure From Peripherally Inserted Central catheters Correlates Well With That of Centrally Inserted Central Catheters

KFSH RC, Riyadh, Saudi Arabia

PURPOSE: To compare CVP measured by CICCs through the distal port of a triple lumen catheter size; with the transducer at the level of the heart; with CVP measured via distal port of the PICCs with transducer level at –4, -2, 0, +2, and +4 from heart.

METHODS: Measurements of central venous pressure were recorded from patients who had an indwelling CICC and PICC concomitantly. Pressure measurements were taken from 18-gauge dual-lumen PICCs and from 16-gauge CICCs all with continuous pressure infusion devices. Central venous pressure measurements, using a pressure infusion device to overcome the natural resistance of the PICC, were taken from both the CICC and the PICC at the level of the heart simultaneously. Two more readings were taken from the PICC, both at 2 and 4 cm above and below the heart respectively. This cycle was repeated 6 times in each patient. Measurements were recorded at end-expiration.

RESULTS: 120 pairs of CVP readings were obtained from 20 paients. Among these, 12 had femoral access and 8 were mixed between internal jugular and subclavian.For measuring and comparing the agreement between CVP from CICC and CVP FROM PICC, concordence correlation (Rc) was calculated. The Rc was 0.99 at the level of the heart (Rc value between 0.9-1, means substantial agreement). See the table
Table 1 Rc values in the 20 patients

Measurements RC Peripherally Inserted Central Catheter at 4 cm above the heart level 0.906 Peripherally Inserted Central Catheter at 2 cm above the heart level 0.972 Peripherally Inserted Central Catheter 0.992 Peripherally Inserted Central Catheter at 2 cm below the heart level 0.941 Peripherally Inserted Central Catheter at 4 cm below the heart level 0.834

below.

CONCLUSION: Central venous pressure measured through a peripherally inserted central catheter at the level of the heart had substantial agreement with central venous pressure measured through centrally inserted central catheter, at the same level. This applies to femoral internal jagular and subclavian access.

CLINICAL IMPLICATIONS: Measuring CVP from PICCs is possible without subjecting the patient to invasive procedures.With an additional benefit of central venous pressure monitoring from PICCs, more institutions may adopt increasing use of PICCs in acute settings. Nurse led PICC line insertion was found to be successful, which would be of great help in decreasing the work load on physician in intensive care units.
Table 2 Rc values in the subgroup of patients (femoral acess vs neck lines)

Measurements Femoral lines IJ and SC lines* Peripherally Inserted Central Catheter at 4 cm above the heart level 0.8961 0.9239 Peripherally Inserted Central Catheter at 2 cm above the heart level 0.9673 0.9822 Peripherally Inserted Central Catheter 0.9922 0.9935 Peripherally Inserted Central Catheter at 2 cm below the heart level 0.9393 0.9515 Peripherally Inserted Central Catheter at 4 cm below the heart level 0.8326 0.8442

IJ = intrnal jugular SC = SubClavian

DISCLOSURE: M. Hijazi, None.