Full Text:   <2688>

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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: 4138

Citations:  Bibtex RefMan EndNote GB/T7714


Wen-qiao Yu


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


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.

@article{title="Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables",
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",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%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
%J Journal of Zhejiang University SCIENCE B
%V 17
%N 1
%P 60-66
%@ 1673-1581
%D 2016
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1500167

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
VL - 17
IS - 1
SP - 60
EP - 66
%@ 1673-1581
Y1 - 2016
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1500167

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.




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


[1]Ambesh, S.P., Pandey, J.C., Dubey, P.K., 2001. Internal jugular vein occlusion test for rapid diagnosis of misplaced subclavian vein catheter into the internal jugular vein. Anesthesiology, 95(6):1377-1379.

[2]Banks, P.A., Bollen, T.L., Dervenis, C., et al., 2013. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1):102-111.

[3]Belda, F.J., Aguilar, G., Teboul, J.L., et al., 2011. Complications related to less-invasive haemodynamic monitoring. Br. J. Anaesth., 106(4):482-486.

[4]Bendjelid, K., Giraud, R., Siegenthaler, N., et al., 2010. Validation of a new transpulmonary thermodilution system to assess global end-diastolic volume and extravascular lung water. Crit. Care, 14(6):R209.

[5]Cannesson, M., Pestel, G., Ricks, C., et al., 2011. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit. Care, 15(4):R197.

[6]Della Rocca, G., Costa, M.G., Pompei, L., et al., 2002. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br. J. Anaesth., 88(3):350-356.

[7]Della Rocca, G., Costa, M.G., Pietropaoli, P., 2007. How to measure and interpret volumetric measures of preload? Curr. Opin. Crit. Care, 13(3):297-302.

[8]Dubey, P.K., Kumar, H., 2002. Pain in the ear resulting from misplaced subclavian dialysis catheter into ipsilateral internal jugular vein. Anesth Analg, 94(6):1460-1461.

[9]Eichhorn, V., Goepfert, M.S., Eulenburg, C., et al., 2012. Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: a meta-analysis of the literature. Med. Intensiva, 36(7):467-474.

[10]Goel, S., Tandon, M., Panigrahi, B., 2010. Bedside technique to detect misplaced subclavian vein catheter in internal jugular vein. Ann. Card. Anaesth., 13(1):71-72.

[11]Heid, F., Muller, N., Piepho, T., et al., 2008. Postoperative analgesic efficacy of peripheral levobupivacaine and ropivacaine: a prospective, randomized double-blind trial in patients after total knee arthroplasty. Anesth. Analg., 106(5):1559-1561.

[12]Katzenelson, R., Perel, A., Berkenstadt, H., et al., 2004. Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit. Care Med., 32(7):1550-1554.

[13]Khan, S., Trof, R.J., Groeneveld, A.B., 2007. Transpulmonary dilution-derived extravascular lung water as a measure of lung edema. Curr. Opin. Crit. Care, 13(3):303-307.

[14]Kiefer, N., Hofer, C.K., Marx, G., et al., 2012. Clinical validation of a new thermodilution system for the assessment of cardiac output and volumetric parameters. Crit. Care, 16(3):R98.

[15]Kuzkov, V.V., Kirov, M.Y., Sovershaev, M.A., et al., 2006. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit. Care Med., 34(6):1647-1653.

[16]Michard, F., Schachtrupp, A., Toens, C., 2005. Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients. Crit. Care Med., 33(6):1243-1247.

[17]O'Grady, N.P., Alexander, M., Burns, L.A., et al., 2011. Guidelines for the prevention of intravascular catheter-related infections. Clin. Infect. Dis., 52(9):e162-e193.

[18]Rath, G.P., Bithal, P.K., Toshniwal, G.R., et al., 2009. Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein. Br. J. Anaesth., 102(4):499-502.

[19]Reuter, D.A., Felbinger, T.W., Schmidt, C., et al., 2005. Trendelenburg positioning after cardiac surgery: effects on intrathoracic blood volume index and cardiac performance. Eur. J. Anaesthesiol., 20(1):17-20.

[20]Sakka, S.G., Bredle, D.L., Reinhart, K., et al., 1999. Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock. J. Crit. Care, 14(2):78-83.

[21]Sakka, S.G., Reuter, D.A., Perel, A., 2012. The transpulmonary thermodilution technique. J. Clin. Monit. Comput., 26(5):347-353.

[22]Saugel, B., Umgelter, A., Schuster, T., et al., 2010. Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter. Crit. Care, 14(3):R95.

[23]Schmidt, S., Westhoff, T.H., Hofmann, C., et al., 2007. Effect of the venous catheter site on transpulmonary thermodilution measurement variables. Crit. Care Med., 35(3):783-786.

[24]Starr, D.S., Cornicelli, S., 1986. EKG guided placement of subclavian CVP catheters using J-wire. Ann. Surg., 204(6):673-676.

[25]Vincent, J.L., Rhodes, A., Perel, A., et al., 2011. Clinical review: update on hemodynamic monitoring—a consensus of 16. Crit. Care, 15(4):229.

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