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Usefulness of a central venous catheter during hepatic surgery
Author(s) -
STÉPHAN F.,
REZAIGUIADELCLAUX S.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01553.x
Subject(s) - medicine , central venous pressure , confidence interval , central venous catheter , catheter , venous pressure , anesthesia , surgery , hemodynamics , blood pressure , heart rate
Aim: Central venous catheter (CVC) is often inserted during liver resection because a low central venous pressure (CVP) reduces blood loss and the procedure may be associated with circulatory impairment. The aim of the study was to evaluate the usefulness of a CVC besides the measurements of CVP, and whether peripheral venous pressure (PVP) measurement could be used reliably in place of CVP. Methods: We conducted an observational study during a 16‐month period. Number of CVC inserted, expected surgical difficulties, and intraoperative complications which could lead to treatment involving a CVC were prospectively recorded and analysed. Measurements of CVP and PVP were simultaneously obtained at different times during surgery. Bias and limits of agreement with their 95% confidence interval (95% CI) were calculated. Results: Of the 101 patients included, 28 had expected surgical difficulties. Of the 75 CVCs inserted, only six (8%) were used for another purpose that CVP measurement in patients with expected surgical difficulties. A total of 124 measurements in 23 patients were recorded. Mean CVP was 4.8 ± 2.9 mmHg and mean PVP was 6.9 ± 3.1 mmHg ( P <0.0001). The bias was −2.1 ± 1.1 mmHg (95% CI: −2.3 to −1.9). When adjusted by the average bias of −2 mmHg, PVP predicted a CVP≤5 mmHg with a sensitivity and a specificity of 93% and 87%, respectively. Conclusion: Routine insertion of a CVC should be discussed in patients without expected surgical difficulties. Thus, PVP monitoring may suffice to estimate CVP in uncomplicated cases.