Usefulness of a central venous catheter during hepatic surgery.
OBJECTIVE
Central venous catheter (CVC) is often inserted during liver resection because a low central venous pressure (CVP) reduces blood loss and the procedure may be associated with circulatory impairment. The aim of the study was to evaluate the usefulness of a CVC besides the measurements of CVP, and whether peripheral venous pressure (PVP) measurement could be used reliably in place of CVP.


METHODS
We conducted an observational study during a 16-month period. Number of CVC inserted, expected surgical difficulties, and intraoperative complications which could lead to treatment involving a CVC were prospectively recorded and analysed. Measurements of CVP and PVP were simultaneously obtained at different times during surgery. Bias and limits of agreement with their 95% confidence interval (95% CI) were calculated.


RESULTS
Of the 101 patients included, 28 had expected surgical difficulties. Of the 75 CVCs inserted, only six (8%) were used for another purpose that CVP measurement in patients with expected surgical difficulties. A total of 124 measurements in 23 patients were recorded. Mean CVP was 4.8 +/- 2.9 mmHg and mean PVP was 6.9 +/- 3.1 mmHg (P<0.0001). The bias was -2.1 +/- 1.1 mmHg (95% CI: -2.3 to -1.9). When adjusted by the average bias of -2 mmHg, PVP predicted a CVP</=5 mmHg with a sensitivity and a specificity of 93% and 87%, respectively.


CONCLUSIONS
Routine insertion of a CVC should be discussed in patients without expected surgical difficulties. Thus, PVP monitoring may suffice to estimate CVP in uncomplicated cases.
Stéphan
F
F
Service d'Anesthésie, Centre Hospitalo-Universitaire de Pointe-à-Pitre, France et Université des Antilles et de la Guyane, Pointe-à-Pitre Cedex, Guadeloupe, France. guadeloupe_stephan@yahoo.fr
Rezaiguia-Delclaux
S
S
D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002496:Central Venous Pressure / Q000502:physiology*; D002985:Clinical Protocols; D016001:Confidence Intervals; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors; D014690:Venous Pressure / Q000502:physiology*