title: Intraoperative peripherally inserted central venous catheter central venous pressure monitoring in abdominal aortic aneurysm reconstruction.
abstract: Numerous studies have found no clinically significant benefit to the perioperative use of pulmonary artery catheters (PACs), and peripherally inserted central venous catheters (PICCs) have been reported to measure central venous pressure (CVP) accurately. The objective of this study was to determine whether the dynamic shifts in preload associated with elective reconstruction of abdominal aortic aneurysms (AAAs) are accurately reflected by CVP measurements from open-ended PICCs compared to CVP measurements from concomitant indwelling PACs. This is a retrospective review of prospectively collected data. PICCs and PACs were placed preoperatively in five patients undergoing elective AAA reconstruction. CVP measurements were recorded every 15 min during the operation. Bland-Altman statistical analysis was used to determine the degree of agreement in data collected by the two measurement devices. Seventy-three paired measurements of CVP from concomitant indwelling PICCs and PACs obtained from five patients undergoing elective AAA reconstruction revealed PICC measurements to be higher than PAC measurements by 0.6 mm Hg (overall correlation coefficient 0.92). The difference between the two measurement devices was expected to be <3.4 mm Hg at least 95% of the time. The findings of this pilot study indicate that PICCs are an effective method for CVP monitoring in situations of dynamic systemic compliance and preload, such as those observed during elective AAA reconstruction.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA. mclemore.elisabeth@mayo.edu
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McLemore
authors.forename: Deron J
authors.initials: DJ
authors.lastname: Tessier
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Rady
authors.forename: Joel S
authors.initials: JS
authors.lastname: Larson
authors.forename: Jeff T
authors.initials: JT
authors.lastname: Mueller
authors.forename: William M
authors.initials: WM
authors.lastname: Stone
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fowl
authors.forename: Bhavesh M
authors.initials: BM
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology* / Q000601:surgery*; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures