Abstract
To determine the equivalency of pressure measurements from peripherally inserted central catheters (PICCs) versus centrally inserted central venous catheters (CVCs) in vitro as well as in vivo. The in vitro study was performed in a clinical laboratory. Static pressure measurements from PICCs and CVCs were obtained in vitro over a physiologic range of 5–25 mmHg. Triple and dual lumen PICCs were directly compared to CVC controls. Dynamic pressure waveforms were recorded to simulate physiologic intravascular pressure variation. The in vivo study was executed in the medical intensive care unit (MICU) of a tertiary-level academic medical center. Data was collected from ten adult patients with both a PICC and a CVC in place for on-going clinical care. Measurements of central venous pressure (CVP) were recorded simultaneously from PICCs and CVCs. Duplicate measurements were taken after a stable waveform was recorded. For the in vitro study, a total of 540 pressure measurements were recorded. The average bias determined by Bland–Altman plot was 0 mmHg for the 5Fr PICC and 0.071 mmHg for the 6Fr PICC. The correlation coefficient for both catheters was 1.0 (P < 0.001). Dynamic pressure waveforms revealed equivalent amplitude. During the in vivo trial, 70 CVP measurements were collected. The paired CVP measurements were found to be highly reliable across subjects (r = 0.99, P < 0.0001). No significance in the average difference in CVP measurement (PICC–CVC) was determined by the Wilcoxon Signed Rank test (S = 1, P = 0.93). In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients.
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Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: sampling, selection, and society. Crit Care. 2004;8(4):222–6.
Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244–50. doi:10.1097/01.CCM.0000261890.41311.E9.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54.
Eber MR, Laxminarayan R, Perencevich EN, Malani A. Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch Intern Med. 2010;170(4):347–53.
Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35(4):1105–12.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.
Shorr AF, Micek ST, Jackson WL, Kollef MH. Economic implications of an evidence-based sepsis protocol: can we improve outcomes and lower costs? Crit Care Med. 2007;35(5):1257–62.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut J-F, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson T, Townsend S, Vender JS, Zimmerman JL, Vincent J-L. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.
McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123–33.
Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med. 2002;30(2):454–60.
Akers AS, Lakshmipathi C. Peripherally inserted central catheter use in the hospitalized patient: is there a role for the hospitalist? J Hosp Med. 2009;4(6):E1–4.
Raiy BA, Fakih MG, Bryan-Nomides N, Hopfner D, Riegel E, Nenninger T, Rey J, Szpunar S, Kale P, Khatib R. Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control. 2010;38(2):149–53.
Lam S, Scannell R, Roessler D, Smith MA. Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med. 1994;154:1833–7.
Moureau N (2006) It’s all about PICCs: optimal catheter and vein selection prove vital to patient safety intiatives. http://www.nursingmanagement.com.
Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489–95.
Latham HE, Dwyer TT, Gregg BL, Simspon SQ. 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 Anesthesiol. 2010;10(18):1–7.
McLemore EC, Tessier DJ, Rady MY, Larson JS, Mueller JT, Stone WM, Fowl RJ, Patel BM. Intraoperative peripherally inserted central venous catheter central venous pressure monitoring in abdominal aortic aneurysm reconstruction. Ann Vasc Surg. 2006;20:577–81.
Black IH, Blosser SA, Murray WB. Central venous pressure measurements: peripherally inserted catheters versus centrally inserted catheters. Crit Care Med. 2000;28(12):3833–6.
Marik PE, Vahid B. Does central venous pressure predict fluid responsiveness? A sysmatic review of the literature and the tale of seven mares. Chest. 2008;134:172–8.
Fearonce G, Faraklas I, Saffle JR, Cochran A. Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res. 2010;31(1):31–5. doi:10.1097/BCR.0b013e3181cb8eaa.
Loewenthal MR, Dobson PM, Starkey RE, Dagg SA, Petersen A, Boyle MJ. The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion. Anaesth Intensive Care. 2002;30(1):21–4.
Cowl CT, Weinstock JV, Al-Jurf A, Ephgrave K, Murray JA, Dillon K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr. 2000;19(4):237–43. doi:10.1054/clnu.2000.0103.
Turcotte S, Dube S, Beauchamp G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg. 2006;30(8):1605–19. doi:10.1007/s00268-005-0174-y.
Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology. 2010;256(1):312–20. doi:10.1148/radiol.10091860.
Polderman KH, Girbes ARJ. Central venous catheter use part 1: mechanical complications. Intensive Care Med. 2002;28:1–17.
Barber JM, Booth DM, King JA, Chakraverty S. A nurse led peripherally inserted central catheter line insertion service is effective with radiological support. Clin Radiol. 2002;57:352–4.
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Latham, H.E., Rawson, S.T., Dwyer, T.T. et al. Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring. J Clin Monit Comput 26, 85–90 (2012). https://doi.org/10.1007/s10877-012-9337-1
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DOI: https://doi.org/10.1007/s10877-012-9337-1