Influence of the venous catheter site on data of pulse indicator continuous cardiac output monitoring

Abstract

To compare the use of subclavian vein catheter and femoral vein catheter, in monitoring pulse indicator continuous cardiac output (PiCCO) monitoring data cardiac index (CI), extravascular lung water index (EVLWI), and global end-diastolic volume index (GEDVI) with central venous injection of the bolus cold saline injection, in order to determine whether the femoral vein access, which is not typically used, could be used to obtain reliable data. Thirteen patients in Beijing Hospital intensive care unit (ICU) were involved, from January 2007 to March 2009. Each patient was monitored with PiCCOplus device, after an injection of cold saline bolus via both femoral and subclavian venous catheter. Paired t-test and Bland-Altman analysis were used to compare CI, EVLWI and GEDVI values. Data of 39 measurements were collected. The bias between femoral injection and subclavian injection were CI (0.28+/-0.46) L x min(-1) x m(-2), EVLWI (1.05+/-1.89) ml/kg, GEDVI (195.2+/-105.7) ml/m(2), and they were statistically significant (P values was 0.000 5, 0.001 3, <0.0001, respectively). The Bland-Altman analysis showed an clinically overestimation of GEDVI after femoral injection (limit of concordance was -11.9, 402.3), compared with that after subclavian injection. Measurements with a cold saline bolus via a femoral catheter, compared to those via a subclavian catheter, lead to overestimation of CI, EVLWI and GEDVI values, and a great bias of GEDVI should be taken into account in clinical work.