title: Can peripheral venous pressure be an alternative to central venous pressure during right hepatectomy in living donors?
abstract: The safety of living donors is a matter of cardinal importance in addition to obtaining optimal liver grafts to be transplanted. Central venous pressure (CVP) is known to have significant correlation with the amount of bleeding during parenchymal transection and many centers have adopted CVP monitoring for right hepatectomy. However, central line cannulation can induce some serious complications. Peripheral venous pressure (PVP) has been suggested as a comparable alternative to CVP. The aim of this study was to determine whether a clinically acceptable agreement or a reliable correlation between CVP and PVP exist and if CVP can be replaced by PVP in living liver donors. A central venous catheter was placed through the right internal jugular vein and a peripheral venous catheter was inserted at antecubital fossa in the right arm. CVP and PVP were recorded in 15-minute intervals in 50 adult living donors. The paired data were divided into 3 stages: preparenchymal transection, parenchymal transection, and postparenchymal transection. A total of 1,430 simultaneous measurements of CVP and PVP were recorded. Overall, the PVP, CVP, and bias were 7.0+/-2.46, 5.9+/-2.32, and 1.16+/-1.12 mmHg, respectively. A total of 88.9% of all measurements were clinically within acceptable limits of bias (+/-2 mmHg). Regression analysis showed a high correlation coefficient between PVP and CVP (r=0.893; P<0.001) and the limits of agreement were -1.03 to 3.34 overall. In conclusion, frequencies of differences, bias, correlation coefficient, and limits of agreement between PVP and CVP remained relatively constant throughout the operation. Therefore, PVP measurement in the arm can be an alternative to predict CVP and further, obviate central venous catheter-related complications in living liver donors.
authors: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
authors: Soo Joo
authors: SJ
authors: Choi
authors: Mi Sook
authors: MS
authors: Gwak
authors: Justin Sang
authors: JS
authors: Ko
authors: Gaab Soo
authors: GS
authors: Kim
authors: Tae Hyeong
authors: TH
authors: Kim
authors: Hyun
authors: H
authors: Ahn
authors: Jie Ae
authors: JA
authors: Kim
authors: Mikyung
authors: M
authors: Yang
authors: Sang
authors: S
authors: Lee
authors: Myung
authors: M
authors: Kim
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D002496:Central Venous Pressure / Q000502:physiology; D016001:Confidence Intervals; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011379:Prognosis; D014690:Venous Pressure / Q000502:physiology*