Advertisement

Journal of Clinical Monitoring and Computing

, Volume 31, Issue 5, pp 943–949 | Cite as

Identifying the position of the right atrium to align pressure transducer for CVP

Spirit level or 3D electromagnetic positioning?
  • S. Avellan
  • I. Uhr
  • D. McKelvey
  • Soren SondergaardEmail author
Original Research

Abstract

The central venous pressure, CVP, is an important variable in the management of selected perioperative and intensive care cases and in clinical decision support systems, CDSS. In current routine, when measuring CVP the health care provider may use anatomical landmarks and a spirit level, SL, to adjust the pressure transducer to the level of the tricuspid valve, i.e. the phlebostatic axis. The aim of the study was to assess the agreement in the postoperative setting between the SL method and electromagnetic 3D positioning (EM). CVP was measured with patients in positions dictated by nursing routines. The staff members measured CVP using SL to position the transducer at the perceived phlebostatic level. This position was compared to coordinates based on an electromagnetic field with external sensors at anatomical landmarks and an internal sensor in the CV catheter for 3D determination of the phlebostatic axis. An electronic survey took bearing on the accepted error in measurement among colleagues at the department. There was a clinically relevant difference between the CVP measured by the staff members and the CVP based on the 3D EM positioning. The limits of agreement extended in excess of ±8 mmHg and half of the measurements had deviations outside an accepted error range of ±2.5 mmHg. There was a large variation in CVP measurements when assessing the agreement with the current method. This may indicate the need for improvement in accuracy, e.g. using the electromagnetic field positioning system, in association with routine monitoring and clinical decision support systems.

Keywords

Central venous pressure Instrumentation Methods physiology Electromagnetic field Diagnostic use 

Notes

Acknowledgments

David Wilkes, Vygon, Ecouen, France is warmly acknowledged for developing and providing the multilumen CVCs with one lumen blinded.

Author’s contribution

S.A.: Designed the study, developed materials and methods, performed and analyzed measurements. Wrote draft of manuscript. I.U.: Designed the study, developed materials and methods, performed and analyzed measurements. Wrote draft of manuscript. D.M.: Derived the algorithms for vector analysis of measurements and implemented them in Excel. S.S.: Conceived and designed the study. Assisted in development of materials and methods and analyzed measurements. Reviewed and corrected draft of manuscript. All authors reviewed and accepted the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interest.

Informed consent

The study was approved by the Gothenburg Regional Ethics Committee (Reg. no. 019-14). Participants received oral and written information during the preoperative assessment before signing consent.

Supplementary material

10877_2016_9918_MOESM1_ESM.docx (129 kb)
Supplementary material 1 (DOCX 129 kb)
10877_2016_9918_MOESM2_ESM.docx (41 kb)
Supplementary material 2 (DOCX 41 kb)

References

  1. 1.
    Marik PE. Handbook of evidence-based critical care. 2nd ed. New York: Springer; 2010.CrossRefGoogle Scholar
  2. 2.
    Sondergaard S, Parkin G, Aneman A. Central venous pressure: we need to bring clinical use into physiological context. Acta Anaesthesiol Scand. 2015;59(5):552–60. doi: 10.1111/aas.12490.CrossRefPubMedGoogle Scholar
  3. 3.
    Li Z, Sun YM, Wu FX, Yang LQ, Lu ZJ, Yu WF. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. World J Gastroenterol WJG. 2014;20(1):303–9. doi: 10.3748/wjg.v20.i1.303.CrossRefPubMedGoogle Scholar
  4. 4.
    Wolmesjö N. Reducing blood loss within liver surgery. Department of Anaesthesia, General Surgery and Intensive care; Sahlgrenska University Hospital, Gothenburg University; 2013.Google Scholar
  5. 5.
    Correa-Gallego C, Berman A, Denis SC, Langdon-Embry L, O’Connor D, Arslan-Carlon V, Kingham TP, D’Angelica MI, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, Melendez J, Fischer M. Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases. HPB Off J Int Hepato Pancreato Biliary Asso. 2014;. doi: 10.1111/hpb.12347.Google Scholar
  6. 6.
    Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, Payen D. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013;17(6):R278. doi: 10.1186/cc13133.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Parkin WG. Volume state control—a new approach. Crit Care and Resusc J Austr Acad Crit Care Med. 1999;1(3):311–21.Google Scholar
  8. 8.
    Magder S, Bafaqeeh F. The clinical role of central venous pressure measurements. J Intensive Care Med. 2007;22(1):44–51. doi: 10.1177/0885066606295303.CrossRefPubMedGoogle Scholar
  9. 9.
    Gelman S. Venous function and central venous pressure: a physiologic story. Anesthesiology. 2008;108(4):735–48. doi: 10.1097/ALN.0b013e3181672607.CrossRefPubMedGoogle Scholar
  10. 10.
    Magder S. How to use central venous pressure measurements. Current Opin Crit Care. 2005;11(3):264–70.CrossRefGoogle Scholar
  11. 11.
    Magder S. Hemodynamic monitoring in the mechanically ventilated patient. Curr Opin Crit Care. 2011;17(1):36–42. doi: 10.1097/MCC.0b013e32834272c1.CrossRefPubMedGoogle Scholar
  12. 12.
    Pedersen A, Husby J. Venous pressure measurement. I. Choice of zero level. Acta Med Scand. 1951;141(3):185–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Bo LE, Leira HO, Tangen GA, Hofstad EF, Amundsen T, Lango T. Accuracy of electromagnetic tracking with a prototype field generator in an interventional OR setting. Med Phys. 2012;39(1):399–406. doi: 10.1118/1.3666768.CrossRefPubMedGoogle Scholar
  14. 14.
    Walder B, Maillard J, Lubbeke A. Minimal clinically important difference: a novel approach to measure changes in outcome in perioperative medicine. Eur J Anaesthesiol. 2015;32(2):77–8. doi: 10.1097/EJA.0000000000000147.CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson M, Mannar R, Wu AV. Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg. 1998;85(2):188–90. doi: 10.1046/j.1365-2168.1998.00570.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet. 1995;346(8982):1085–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Olofsen E, Dahan A, Borsboom G, Drummond G. Improvements in the application and reporting of advanced Bland-Altman methods of comparison. J Clin Monit Comput. 2015;29(1):127–39. doi: 10.1007/s10877-014-9577-3.CrossRefPubMedGoogle Scholar
  19. 19.
    Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–506. doi: 10.1056/NEJMoa1404380.CrossRefPubMedGoogle Scholar
  20. 20.
    Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, Pro MTI. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301–11. doi: 10.1056/NEJMoa1500896.CrossRefPubMedGoogle Scholar
  21. 21.
    Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol-based care for early septic shock. New Engl J Med. 2014;370(18):1683–93. doi: 10.1056/NEJMoa1401602.CrossRefPubMedGoogle Scholar
  22. 22.
    McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267–77. doi: 10.1016/j.jclinepi.2013.08.015.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Guyton AC, Greganti FP. A physiologic reference point for measuring circulatory pressures in the dog; particularly venous pressure. Am J Physiol. 1956;185(1):137–41.PubMedGoogle Scholar
  24. 24.
    Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Columb MO. Clinical measurement and assessing agreement. Curr Anaesth Criti Care. 2008;19(5–6):328–9. doi: 10.1016/j.cacc.2008.07.001.CrossRefGoogle Scholar
  26. 26.
    Parkin WG, Leaning MS. Therapeutic control of the circulation. J Clin Monit Comput. 2008;22(6):391–400. doi: 10.1007/s10877-008-9147-7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Medical SchoolUniversity of GothenburgGothenburgSweden
  2. 2.Chalmers University of TechnologyGothenburgSweden
  3. 3.Centre of Elective SurgerySilkeborg Regional HospitalSilkeborgDenmark

Personalised recommendations