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Published on: August 1, 2018
Different injection techniques in the assessment of central haemodynamics in patients with cirrhosis
Tine N Christensen1, Christian Mortensen, Jens H Henriksen
1Centre of Functional Imaging and Research, Department of Clinical Physiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Insights
Accurate central haemodynamics measurement in cirrhosis patients is crucial. An alternative catheter injection technique for radiolabelled albumin provides more precise central blood volume and circulation time values compared to traditional syringe injection.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Cirrhosis patients often exhibit altered blood volume distribution, with reduced central blood volume (CBV) and central circulation time (CCT).
- Accurate assessment of central hemodynamics is vital for managing these patients.
Purpose of the Study:
- To compare an alternative catheter lumen injection technique with the conventional syringe injection technique for measuring central hemodynamics.
- To evaluate the impact of injection method on the determination of CBV, CCT, and cardiac output (CO) in cirrhosis patients.
Main Methods:
- Simultaneous injection of technetium-labeled human serum albumin ((99m)Tc-HSA) via catheter deposit and iodine-labeled human serum albumin ((125)I-HSA) via syringe.
- Determination of CCT, CBV, and CO in 192 cirrhosis patients using kinetic principles.
- Arterial blood sampling every second for the first minute post-injection.
Main Results:
- The alternative catheter deposit injection technique yielded significantly shorter CCT and lower CO and CBV compared to the traditional syringe technique.
- The mean difference (bias) in CCT between the two methods was 0.38 seconds, with limits of agreement from -0.83 to 1.59 seconds.
Conclusions:
- Different injection techniques lead to minor but significant variations in measured hemodynamics.
- The alternative catheter deposit injection method is recommended for achieving highly accurate central hemodynamic measurements in cirrhosis, reducing CCT overestimation.
Objective:
Patients with cirrhosis often present with an abnormal distribution of blood volume with a reduced central blood volume (CBV) and central circulation time (CCT). In this group of patients it is important to determine the central haemodynamics as accurately as possible. The purpose of the present study was to compare an alternative injection technique by injecting technetium-labelled human serum albumin ((99m)Tc-HSA) from a deposit within the catheter lumen with the conventional injection technique by injecting iodine-labelled human serum albumin ((125)I-HSA) directly from a syringe.
Materials And Methods:
In 192 patients with cirrhosis, CCT, CBV, and cardiac output (CO) were determined according to kinetic principles. Injection of the two radiolabelled HSA were performed simultaneously and followed by arterial blood sampling every second for the first minute.
Results:
CCT was significantly shorter, and CO and CBV were significantly lower when determined by the alternative catheter deposit injection technique compared to determination by the traditional syringe deposit injection technique. The mean difference (bias) between CCT measured with the two methods was 0.38 s with limits of agreement ranging from - 0.83 s to 1.59 s.
Conclusion:
This study demonstrates that different injection techniques result in a minor but significant difference of the measured haemodynamics. When highly accurate measurements of the central haemodynamics are needed, we recommend using the alternative injection technique by injection of the indicator from a deposit within the catheter in order to reduce overestimation of CCT.
