Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables
Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables
复制标题
锁骨下静脉导管误置入颈静脉对经肺热稀释测量变量的影响
DOI：
10.1631/jzus.b1500167
复制
发表时间：
2016-01-01
影响因子：
5.1
通讯作者：
Liang, Ting-bo
中科院分区：
文献类型：
--
作者：
Yu, Wen-qiao;Zhang, Yun;Liang, Ting-bo
ObjectiveThe subclavian vein (SCV) is usually used to inject the indicator of cold saline for a transpulmonary thermodilution (TPTD) measurement. The SCV catheter being misplaced into the internal jugular (IJV) vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables.MethodsThirteen severe acute pancreatitis (SAP) patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index (CI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI) were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and misplaced SCV accesses.ResultsA total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of +111.40 ml/m2 (limits of agreement: 6.13 and 216.70 ml/m2) for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of +0.17 L/(min·m2) for CI and +0.17 ml/kg for EVLWI were revealed by Bland-Altman analysis.ConclusionsThe malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.中文概要目 的临床上锁骨下静脉导管误入颈内静脉时有发生,但错误导管位置是否对PiCCO 监测数据结果有影响,从而导致临床医生对患者病情出现误判目前尚不清楚。本研究的主要目的是观察错误导管位置对PiCCO 数据(如全心舒张末容积指数(GEDVI)、血管外肺水指数(ELWI)、胸腔内血容积指数(ITBVI)和心指数(CI))的影响。创新点目前临床医生对锁骨下静脉导管的位置不够重视,更不会了解错误导管对临床血流动力学监测的影响,从而做出错误的临床决策。本研究提出错误导管位置对PiCCO 数据的影响,再次强调确认正确锁骨下静脉导管位置的重要性,并提出如何判断导管在正确位置的床边小技巧。方 法本研究回顾性分析13 例重症胰腺炎病人接受错误导管位置的PiCCO 测量后,与正确位置导管的PiCCO 数据进行对比,分析错误导管位置对PiCCO 数据包括GEDVI、ELWI、ITBVI 和CI的影响。结 论错误的锁骨下静脉导管导致GEDVI 和ITBVI 数据偏高,而对CI 及ELWI 的影响无统计学意义,因此,正确的导管位置对临床PiCCO 监测的数据很重要。