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Variability in the establishment of an external reference point for central venous pressure measurement in children

Aline S C Belela1, Mavilde L G Pedreira, Maria Angélica S Peterlini

  • 1Cuidados Intensivos Pediátricos, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.

Jornal De Pediatria
|September 9, 2006
PubMed

Insights

Healthcare workers show significant variability in identifying the midaxillary line for central venous pressure measurement in children. Experienced professionals may underestimate this reference point, potentially impacting patient safety.

Area of Science:

  • Pediatric critical care medicine
  • Medical measurement techniques
  • Patient safety protocols

Background:

  • Accurate central venous pressure (CVP) measurement is crucial for pediatric intensive care.
  • The midaxillary line is a commonly used external reference point (ERP) for CVP measurement.
  • Variability in ERP establishment can affect measurement accuracy and clinical decision-making.

Purpose of the Study:

  • To assess the variability in establishing the midaxillary line as an ERP for CVP measurement in children.
  • To compare measurements made by different healthcare professionals against a trained evaluator.
  • To identify factors influencing the variability of ERP establishment.

Main Methods:

  • A descriptive and correlational study was conducted in a pediatric intensive care unit.
  • 120 assessments of the midaxillary line were performed by 44 healthcare workers (nurses, physicians, assistants) and a trained evaluator.
  • Data were analyzed using chi-square, ANOVA, Kruskal-Wallis, and t-tests.

Main Results:

  • Significant differences (p < 0.001) were found between healthcare workers' and the evaluator's ERP assessments.
  • 46.7% of measurements were lower, 36.7% higher, and 16.7% concordant with the evaluator's.
  • Neither professional category (p = 0.899) nor experience level influenced concordance, but greater experience correlated with sharper deviations.

Conclusions:

  • The midaxillary line as an ERP for CVP measurement shows considerable variability among healthcare teams.
  • Variability is not linked to professional category.
  • Increased experience may lead to underestimation of the ERP, potentially compromising procedure efficacy and patient safety.
Abstract

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