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Measurement of central venous pressure from a peripheral vein in infants and children
Joseph D Tobias1, Joel O Johnson
1Department of Child Health, The University of Missouri, Columbia 65212, USA. Tobiasj@health.missouri.edu
Insights
Central venous pressure (CVP) can be accurately measured using peripheral IV catheters in pediatric patients. This method is reliable when CVP changes with breathing or limb occlusion, ensuring continuity with the central venous compartment.
Area of Science:
- Pediatric critical care medicine
- Vascular access monitoring
- Hemodynamic assessment
Background:
- Adult studies show peripheral IVs can estimate central venous pressure (CVP).
- Limited data exists for pediatric patients regarding peripheral CVP measurement accuracy.
- This study aims to validate peripheral CVP measurement in infants and children.
Purpose of the Study:
- To prospectively compare CVP measurements from peripheral and central venous catheters in pediatric patients.
- To determine the reliability of peripheral CVP measurements in infants and children.
Main Methods:
- Included 30 pediatric patients (<12 years) requiring central venous access.
- Simultaneously measured CVP from peripheral IV and central venous catheters every 15 minutes (10 measurements total).
- Used standard pressure transducers, zeroed at the phlebostatic axis.
Main Results:
- In 25/30 patients, peripheral CVP closely matched central CVP (difference of 5 ± 3 mm Hg).
- In 5/30 patients, peripheral CVP did not respond to inspiratory effort or limb occlusion, showing a significant difference (16 ± 5 mm Hg).
- Measurement accuracy was independent of IV cannula size, location, or patient position.
Conclusions:
- Peripheral IV catheter CVP measurement is feasible in pediatric patients.
- Reliability is confirmed when CVP shows dynamic changes with respiratory maneuvers or limb occlusion.
- This technique can ensure continuity with the central venous compartment in pediatric care.
Background:
Previous studies in adults have demonstrated a clinically useful correlation between central venous pressure (CVP) measured from a peripheral intravenous catheter and that measured from a central venous catheter. The current study prospectively compares CVP measurements from a central catheter and a peripheral catheter in infants and children.
Methods:
The study cohort included patients younger than 12 years presenting for a surgical procedure for which central venous access was necessary. CVP was measured simultaneously every 15 minutes for a total of 10 measurements from the central venous catheter and the peripheral IV catheter using standard pressure transducers, which were zeroed at the phlebostatic axis.
Results:
The cohort for the study included 30 infants and children ranging in age from 1 to 12 years. The peripheral IV catheter from which the CVP was measured ranged from a 24 to an 18 gauge. In 5 of the patients, there was no increase in the CVP value from the peripheral IV catheter in response to a sustained inspiratory breath or occlusion of the extremity above the catheter. In these 5 cases, the difference between the CVP measured from the central and peripheral catheter was 16 +/- 5 mm Hg versus 5 +/- 3 mm Hg in the other 25 patients (P < 0.0001). In the remaining 25 patients, the difference between the CVP measured from the peripheral and the central site was 5 +/- 3 mm Hg. There was no difference in the central versus peripheral CVP measurement depending on the size of the IV cannula, its location (upper versus lower extremity), or the patient's position.
Conclusion:
CVP can be measured from a peripheral IV catheter in infants and children provided that there is continuity with the central venous compartment demonstrated by showing an increase in the CVP from the peripheral IV catheter in response to a sustained inspiratory effort and by occlusion of the extremity above the site of the catheter.
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