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Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

引用

Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2016年第1期17卷 60-66页

作者： Wen-qiao YU Yun ZHANG Shao-yang ZHANG Zhong-yan LIANG Shui-qiao FU Jia XU Ting-bo LIANG Department of Hepatobiliary and Pancreatic Surgery and Intensive Care Unit the Second Affiliated HospitalSchool of MedicineZhejiang University Hangzhou 310021 China Women's Hospital School of MedicineZhejiang University Hangzhou 310006 China Department of Emergency the First Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310003 China

Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary 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. Methods： Thirteen 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 （EVLWl） 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 mis- placed SCV accesses. Results： A 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 re- vealed by Bland-Altman analysis. Conclusions： The 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.

关键词： Transpulmonary thermodUution jugular vein catheter Misplaced subclavian vein catheter Severe acutepancreatitis

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