Full Text:   <1960>

Summary:  <1606>

CLC number: R472

On-line Access: 2016-01-06

Received: 2015-07-09

Revision Accepted: 2015-11-07

Crosschecked: 2015-12-16

Cited: 2

Clicked: 3387

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Wen-qiao Yu

http://orcid.org/0000-0003-3940-2237

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Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.1 P.60-66

http://doi.org/10.1631/jzus.B1500167


Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables


Author(s):  Wen-qiao Yu, Yun Zhang, Shao-yang Zhang, Zhong-yan Liang, Shui-qiao Fu, Jia Xu, Ting-bo Liang

Affiliation(s):  1Department of Hepatobiliary and Pancreatic Surgery and Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310021, China; more

Corresponding email(s):   yuwenqiao_60@hotmail.com, liangtingbo@zju.edu.cn

Key Words:  Transpulmonary thermodilution, Jugular vein catheter, Misplaced subclavian vein catheter, Severe acute pancreatitis


Wen-qiao Yu, Yun Zhang, Shao-yang Zhang, Zhong-yan Liang, Shui-qiao Fu, Jia Xu, Ting-bo Liang. Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables[J]. Journal of Zhejiang University Science B, 2016, 17(1): 60-66.

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author="Wen-qiao Yu, Yun Zhang, Shao-yang Zhang, Zhong-yan Liang, Shui-qiao Fu, Jia Xu, Ting-bo Liang",
journal="Journal of Zhejiang University Science B",
volume="17",
number="1",
pages="60-66",
year="2016",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1500167"
}

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%T Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables
%A Wen-qiao Yu
%A Yun Zhang
%A Shao-yang Zhang
%A Zhong-yan Liang
%A Shui-qiao Fu
%A Jia Xu
%A Ting-bo Liang
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T1 - Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables
A1 - Wen-qiao Yu
A1 - Yun Zhang
A1 - Shao-yang Zhang
A1 - Zhong-yan Liang
A1 - Shui-qiao Fu
A1 - Jia Xu
A1 - Ting-bo Liang
J0 - Journal of Zhejiang University Science B
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SP - 60
EP - 66
%@ 1673-1581
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PB - Zhejiang University Press & Springer
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DOI - 10.1631/jzus.B1500167


Abstract: 
Objective: The subclavian vein (SCV) is usually used to inject the indicator of cold saline for a transpulmonary thermodilution (TPTD) measurement. The SCV catheter being misplaced into the internal jugular (IJV) vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods: Thirteen severe acute pancreatitis (SAP) patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index (CI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI) were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and misplaced SCV accesses. Results: A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of +111.40 ml/m2 (limits of agreement: 6.13 and 216.70 ml/m2) for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of +0.17 L/(min·m2) for CI and +0.17 ml/kg for EVLWI were revealed by Bland-Altman analysis. Conclusions: The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.

锁骨下静脉导管误入颈内静脉对热稀释测量数据的影响

目的:临床上锁骨下静脉导管误入颈内静脉时有发生,但错误导管位置是否对PiCCO监测数据结果有影响,从而导致临床医生对患者病情出现误判目前尚不清楚。本研究的主要目的是观察错误导管位置对PiCCO数据(如全心舒张末容积指数(GEDVI)、血管外肺水指数(ELWI)、胸腔内血容积指数(ITBVI)和心指数(CI))的影响。
创新点:目前临床医生对锁骨下静脉导管的位置不够重视,更不会了解错误导管对临床血流动力学监测的影响,从而做出错误的临床决策。本研究提出错误导管位置对PiCCO数据的影响,再次强调确认正确锁骨下静脉导管位置的重要性,并提出如何判断导管在正确位置的床边小技巧。
方法:本研究回顾性分析13例重症胰腺炎病人接受错误导管位置的PiCCO测量后,与正确位置导管的PiCCO数据进行对比,分析错误导管位置对PiCCO数据包括GEDVI、ELWI、ITBVI和CI的影响。
结论:错误的锁骨下静脉导管导致GEDVI和ITBVI数据偏高,而对CI及ELWI的影响无统计学意义,因此,正确的导管位置对临床PiCCO监测的数据很重要。

关键词:经肺热稀释;颈内静脉导管;错误的锁骨下静脉导管;重症急性胰腺炎

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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