Effect of catheter site on the agreement of peripheral and central venous pressure measurements in neurosurgical patients

Abstract

Study Objective Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical setups. The aim of this study was to investigate the effect of measurement site on PVP and its agreement with CVP in patients undergoing general anesthesia. Design Prospective randomized study. Settings University hospital. Patients Thirty patients of American Society of Anesthesiologists physical status I and II undergoing elective craniotomy. Interventions Patients were randomly assigned into Group A (antecubital; n = 15) and Group D (dorsum hand; n = 15) for antecubital and hand dorsum catheterization sites, respectively. Central venous pressure and PVP were monitored throughout the study. A total of 1925 simultaneous measurements were recorded at 5-minute intervals. Bland-Altman assessment for agreement was used for CVP and PVP in 2 groups. Measurements Peripheral venous pressure measurements were within the range of ±2 mm Hg of CVP values, in 93.9% of the measurements in Group A, and in 91.2% of the measurements in Group D. Considering all measurements, mean bias was −0.072 mm Hg (95% CI, −0.134 to −0.010). Group A measurements showed a bias (CVP-PVP) of 0.173 ± 3.557 mm Hg, whereas the bias was −0.122 ± 4.322 mm Hg (mean ± SD corrected for repeated measurements) in Group D. All of the measurements were within mean ± 2SD of bias, which means that PVP and CVP are interchangeable in our clinical setting. Conclusion Peripheral venous pressure measurement may be a noninvasive alternative for estimating CVP in patients undergoing elective neurosurgical operations. Measuring PVP from hand dorsum does not interfere with the agreement of CVP and PVP.