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Are Peripherally Inserted Central Catheters Suitable for Cardiac Output Assessment With Transpulmonary

Sonia D'Arrigo1, Claudio Sandroni2, Sofia Cacciola1

  • 1Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.

Critical Care Medicine
|July 30, 2019
PubMed

Insights

Peripherally inserted central catheters (PICCs) overestimate hemodynamic measurements like cardiac index when used for transpulmonary thermodilution. This overestimation is more pronounced with double-lumen PICCs, impacting critical care monitoring accuracy.

Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Medical Device Technology

Background:

  • Peripherally inserted central catheters (PICCs) are increasingly utilized in intensive care units (ICUs) for intravenous infusions.
  • The reliability of PICCs for hemodynamic monitoring using transpulmonary thermodilution remains uncertain.
  • Accurate hemodynamic assessment is crucial for managing critically ill patients.

Purpose of the Study:

  • To evaluate the agreement between transpulmonary thermodilution measurements obtained via PICC and central venous catheters (CVCs).
  • To assess the accuracy of hemodynamic monitoring using a Pulse Contour system (VolumeView/EV1000) calibrated with transpulmonary thermodilution via PICCs.
  • To determine if PICC size and lumen configuration affect measurement reliability.

Main Methods:

  • A prospective method-comparison study was conducted in a 20-bed medical-surgical ICU.
  • Twenty adult ICU patients with hemodynamic instability and both PICC and CVC in place were enrolled.
  • Transpulmonary thermodilution measurements were compared using bolus injections through CVCs (reference) and 4F single-lumen or 5F double-lumen PICCs, with both manual and automated injection systems.

Main Results:

  • Use of a 5F double-lumen PICC led to significant overestimation of cardiac index (31% bias) compared to CVC.
  • Global end-diastolic index, extravascular lung water index, and stroke volume index were also significantly overestimated with the 5F double-lumen PICC.
  • A 4F single-lumen PICC showed less, but still significant, overestimation of cardiac index (12.7% bias).
  • Differences persisted even with automated injection, confirming reliability issues.

Conclusions:

  • Bolus injection via PICCs for transpulmonary thermodilution with the EV1000 system results in significant overestimation of key hemodynamic parameters.
  • The overestimation is more severe with 5F double-lumen PICCs, questioning their suitability for accurate hemodynamic monitoring.
  • Clinical decisions based on these measurements may be compromised, necessitating caution when using PICCs for this purpose.
Abstract

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