CVP via Port

[drccw]

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I had a pretty major vascular case today, resection of a renal tumor with IVC involvement. The gal had a port in her right IJ, so I placed a left cordis... For some reason, I decided I wanted to follow CVP trends, so I hooked it up to the port. I got a pretty good waveform, and numbers that I thought looked pretty good (but then again CVP numbers are always a little suspect). The trends seemed to be pretty accurate though. Anyone else have any experience with transduction of ports (or for that matter PICCs)?

 

[cchoukal]

I had a pretty major vascular case today, resection of a renal tumor with IVC involvement. The gal had a port in her right IJ, so I placed a left cordis... For some reason, I decided I wanted to follow CVP trends, so I hooked it up to the port. I got a pretty good waveform, and numbers that I thought looked pretty good (but then again CVP numbers are always a little suspect). The trends seemed to be pretty accurate though. Anyone else have any experience with transduction of ports (or for that matter PICCs)?

We do it in the ICU frequently (mostly because the primary service thinks they want to follow a CVP). Because we never have a reference CVP to which to compare it, it's hard to know how accurate it it. Based on the physics of it, I guess I wouldn't expect it to be different. In the end, it's a transducer in continuity via a fluid column with the lumen of the vessel. Maybe the length of the catheter makes a difference (although the difference in catheter length probably doesn't change the total length of the fluid column relative to the length of the transducer tubing). In the case of the port, there's the acute bend of the huber needle and maybe that does something to the propogation of the pressure within the fluid column, but who knows.

There was some work done at the University of Chicago (made it into abstract form; not sure it was ever published) looking at comparing CVP to a peripheral venous pressure on a large PIV and, although I don't recall the analysis, the two were thought to be comparable.

 

[2win]

We do it in the ICU frequently (mostly because the primary service thinks they want to follow a CVP). Because we never have a reference CVP to which to compare it, it's hard to know how accurate it it. Based on the physics of it, I guess I wouldn't expect it to be different. In the end, it's a transducer in continuity via a fluid column with the lumen of the vessel. Maybe the length of the catheter makes a difference (although the difference in catheter length probably doesn't change the total length of the fluid column relative to the length of the transducer tubing). In the case of the port, there's the acute bend of the huber needle and maybe that does something to the propogation of the pressure within the fluid column, but who knows.

There was some work done at the University of Chicago (made it into abstract form; not sure it was ever published) looking at comparing CVP to a peripheral venous pressure on a large PIV and, although I don't recall the analysis, the two were thought to be comparable.

The same - important is to have the baseline and you can make the decisions in accordance with the "normal" values.
I had a similar case....disaster...
They resected the IVC.
From now on I have a stand by pump. I cannot ask for a better surgeon or a lucky one.

 

[sevoflurane]

I had a pretty major vascular case today, resection of a renal tumor with IVC involvement. The gal had a port in her right IJ, so I placed a left cordis... For some reason, I decided I wanted to follow CVP trends, so I hooked it up to the port. I got a pretty good waveform, and numbers that I thought looked pretty good (but then again CVP numbers are always a little suspect). The trends seemed to be pretty accurate though. Anyone else have any experience with transduction of ports (or for that matter PICCs)?

They work great. As you said... you'd want to follow trends anyways and note the difference before and after they open the belly (loss of intrathoracic pressure). And, yes... the CVP wave form with all it's components usually look pretty good.

As regard to your case. Renal cell is pretty vascular and when it invades the IVC it can get pretty ugly. The last one of these I saw, I was doing TEE after a massive section of the tumor had disslodged during surgical dissection. The patient went into cardiovascular collapse 2/2 RVOT obstruction and air embolus. We started bypass in a non-bypass room. A little crazy. Although we managed to address the CV issues this poor 45 y/o female also had a PFO and ended up brain dead in the ICU 2/2 to a massive stroke. The TEE was very revealing. A river of air swirling around in the RA and making it's way from right to left through a PFO. Then, a clot bouncing around in the RVOT. Some people somtimes have some pretty bad luck I guess. It is cases like these where I try not to forgett how lucky I really am.