An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission
BMC Anesthesiology
An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission
Heath E Latham 0 1
Timothy T Dwyer 0 1
Bethene L Gregg 1 2
Steven Q Simpson 0 1
0 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Kansas Medical Center , Kansas City, Kansas , USA
1 3901 Rainbow Blvd , MS 3007, Kansas City, KS 66160 , USA
2 Division of Respiratory Care Education, University of Kansas Medical Center , Kansas City, Kansas , USA
Background: Early goal directed therapy improves survival in patients with septic shock. Central venous pressure (CVP) monitoring is essential to guide adequate resuscitation. Use of peripherally inserted central catheters (PICC) is increasing, but little data exists comparing a PICC to a conventional CVP catheter. We studied the accuracy of a novel PICC to transmit static and dynamic pressures in vitro. Methods: We designed a device to generate controlled pressures via a column of water allowing simultaneous measurements from a PICC and a standard triple lumen catheter. Digital transducers were used to obtain all pressure readings. Measurements of static pressures over a physiologic range were recorded using 5Fr and 6Fr dual lumen PICCs. Additionally, random repetitive pressure pulses were applied to the column of water to simulate physiologic intravascular pressure variations. The resultant PICC and control waveforms were recorded simultaneously. Results: Six-hundred thirty measurements were made using the 5 Fr and 6 Fr PICCs. The average bias determined by Bland-Altman plot was 0.043 mmHg for 5 Fr PICC and 0.023 mmHg for 6 Fr PICC with a difference range of 1.0 to -1.0. The correlation coefficient for both catheters was 1.0 (p-value < 0.001). Dynamic pressure waveforms plotted simultaneously between PICC and control revealed equal peaks and troughs. Conclusion: In vitro, no static or dynamic pressure differences were found between the PICC and a conventional CVP catheter. Clinical studies are required to assess whether the novel PICC has bedside equivalence to conventional catheters when measuring central venous pressures.
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Background
Sepsis is a major cause of death in the world and carries
a mortality rate of 20 to 60% depending on the severity
of the disease [1]. Severe sepsis and septic shock are the
leading cause of death in non-cardiac intensive care
units and the 10th overall cause of death in the United
States [2]. As the countrys population grows and ages,
the incidence of sepsis is also increasing [1-3]. Despite
profound technological advancements in medicine over
the last two decades, no intervention has impacted the
treatment of severe sepsis and septic shock to the
degree of early goal directed therapy. In 2001, Rivers
and colleagues demonstrated a sixteen percent reduction
in hospital mortality with an early intervention bundle
including aggressive volume resuscitation guided by
central venous pressure (CVP) monitoring [4].
Centrally inserted central catheters (CICC) and
pulmonary artery catheters (PAC) are the current gold
standard instruments for measuring CVP, but insertion of
these catheters carries the risk of pneumothorax,
hemothorax, and severe bleeding [5]. Peripherally inserted
central catheters (PICC) are increasingly used in the
hospital setting, and do not have the same risk of
complications with insertion as compared to centrally inserted
catheters [6]. Interestingly, CVP monitoring is an
indication for use for several commercially available PICCs,
including those manufactured by AngioDynamics, Arrow,
Bard, and Medcomp [7-11]. However, there is limited
literature on functional accuracy of PICCs for measuring
CVP [12,13]. In addition, PICC length and flexibility,
necessary design requirements, intuitively suggest to
clinicians that central venous pressure measurement via PICC
may not be accurate.
For our study, we selected the AngioDynamics Morpheus
PICC. A property unique to the Morpheus catheter is that
the shaft transitions from increased stiffness at the proximal
end to softer flexibility at the distal end [14].
Purpose
The purpose of our study was to assess the accuracy of
static and dynamic pressures measured via the
Morpheus PICC compared to a conventional catheter for
central insertion. We hypothesized that under in vitro
conditions, pressure transmission through the PICC
would be equal to pressure transmission through the
conventional catheter.
Methods
In an in vitro study, we designed an inverted T-device
to generate controlled pressures via a column of water.
The PICC and control were inserted into the device
opposite of each other with the catheter tips at the
base of the column of water, allowing simultaneous
measurements from the PICC and control catheter.
Care was taken to avoid excessive external
compression or bending of the catheters at the insertion
points. The column of water was cali (...truncated)