Are single-lumen 5Fr and triple-lumen 6Fr PICCs suitable for hemodynamic assessment by trans-pulmonary thermodilution? A pilot study

Sonia D'Arrigo, Claudio Sandroni, Sofia Cacciola, Antonio Maria Dell'Anna, Mauro Pittiruti, Maria Giuseppina Annetta, Cesare Colosimo, Massimo Antonelli, Sonia D'Arrigo, Claudio Sandroni, Sofia Cacciola, Antonio Maria Dell'Anna, Mauro Pittiruti, Maria Giuseppina Annetta, Cesare Colosimo, Massimo Antonelli

Abstract

Background: Single-lumen 4Fr or double-lumen 5Fr power injectable peripherally inserted central catheters (PICCs) are not accurate for trans-pulmonary thermodilution (TPTD), since they overestimate cardiac index and other TPTD-derived parameters when compared with centrally inserted central catheters (CICCs) because of the smaller size of their lumen. We hypothesize that PICCs with larger lumen size may be reliable for the cardiac index assessment using the TPTD.

Methods: This is a single-centre, prospective method-comparison study that included adult patients admitted in ICU who required a calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000™) for circulatory shock and had both PICC and CICC in place. We compared TPTD measurements via single-lumen 5Fr or triple-lumen 6Fr polyurethane power injectable PICCs with triple-lumen 7Fr CICC (reference standard). To rule out biases related to manual injection, measurements were repeated using an automated rapid injection system. We performed Bland-Altman analysis accounting for multiple observations per patient.

Results: A total of 320 measurements were performed in 15 patients. During the manual phase, the cardiac index measured with either single-lumen 5Fr or triple-lumen 6Fr PICCs were comparable with cardiac index measured with triple-lumen 7Fr CICC (3.2 ± 1.04 vs. 3.2 ± 1.06 L/min/m2, bias 2.2% and 3.3 ± 0.8 vs. 3.0 ± 0.7 L/min/m2, bias 8.5%, respectively). During the automated phase, triple-lumen 6Fr PICC slightly overestimated the cardiac index when compared to triple-lumen 7Fr CICC (CI 3.4 ± 0.7 vs. 3.0 ± 0.7 L/min/m2, bias 12.5%; p = 0.012). For both single-lumen 5Fr and triple-lumen 6Fr PICCs, percentage error vs. triple-lumen 7Fr CICC was below 20% (14.7% and 19% during the manual phase and 14.4% and 13.8% during the automated phase, respectively). Similar results were observed for TPTD-derived parameters.

Conclusions: During hemodynamic monitoring with TPTD, both single-lumen 5Fr PICCs and triple-lumen 6Fr PICCs can be used for cold fluid bolus injection as an alternative to CICC (ClinicalTrials.gov NCT04241926).

Keywords: Cardiac output; Centrally inserted central catheter; Hemodynamic monitoring; Intensive care unit; Peripherally inserted central catheter; Trans-pulmonary thermodilution.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of study population
Fig. 2
Fig. 2
Bland-Altman plot comparing the difference of cardiac index between CICC and PICC during the manual phase. The solid horizontal line represents the mean bias (%) between the two devices. The two dashed horizontal lines correspond to the limits of agreement (mean bias ± 1.96 times the standard deviation of the differences)
Fig. 3
Fig. 3
Cross section of catheters. A Single-lumen 5fr; B Triple-lumen 6Fr; C Double-lumen 5Fr

References

    1. Black IH, Blosser SA, Murray WB. Central venous pressure measurements: peripherally inserted catheters versus centrally inserted catheters. Crit Care Med. 2000;28(12):3833–3836. doi: 10.1097/00003246-200012000-00014.
    1. Latham HE, Rawson ST, Dwyer TT, Patel CC, Wick JA, Simpson SQ. Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring. J Clin Monit Comput. 2012;26(2):85–90. doi: 10.1007/s10877-012-9337-1.
    1. Latham HE, Dwyer TT, Gregg BL, Simpson SQ. An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission. BMC Anesthesiol. 2010;10:18. doi: 10.1186/1471-2253-10-18.
    1. McLemore EC, Tessier DJ, Rady MY, Larson JS, Mueller JT, Stone WM, Fowl RJ, Patel BM. Intraoperative peripherally inserted central venous catheter central venous pressure monitoring in abdominal aortic aneurysm reconstruction. Ann Vasc Surg. 2006;20(5):577–581. doi: 10.1007/S10016-006-9108-x.
    1. Yun JY, Park SH, Cho DS, Jeung HJ, Lee SA, Seo SJ. Comparison of the central venous pressure from internal jugular vein and the pressure measured from the peripherally inserted antecubital central catheter (PICCP) in liver transplantation recipients. Korean J Anesthesiol. 2011;61(4):281–287. doi: 10.4097/kjae.2011.61.4.281.
    1. Sanfilippo F, Noto A, Martucci G, Farbo M, Burgio G, Biasucci DG. Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis. J Vasc Access. 2017;18(4):273–278. doi: 10.5301/jva.5000749.
    1. D’Arrigo S, Sandroni C, Cacciola S, Dell’Anna AM, Pittiruti M, Annetta MG, Colosimo C, Antonelli M. Are peripherally inserted central catheters suitable for cardiac output assessment with transpulmonary thermodilution? Crit Care Med. 2019;47(10):1356–1361. doi: 10.1097/CCM.0000000000003917.
    1. Pittiruti M, La Greca A, Scoppettuolo G. The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access. 2011;12(4):280–291. doi: 10.5301/JVA.2011.8381.
    1. Yamamoto AJ, Solomon JA, Soulen MC, Tang J, Parkinson K, Lin R, Schears GJ. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol. 2002;13(1):77–81. doi: 10.1016/S1051-0443(07)60012-8.
    1. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17(4):571–582. doi: 10.1080/10543400701329422.
    1. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85–91. doi: 10.1023/A:1009982611386.
    1. Zou GY. Confidence interval estimation for the Bland-Altman limits of agreement with multiple observations per individual. Stat Methods Med Res. 2013;22(6):630–642. doi: 10.1177/0962280211402548.
    1. Odor PM, Bampoe S, Cecconi M. Cardiac output monitoring: validation studies-how results should be psresented. Curr Anesthesiol Rep. 2017;7(4):410–415. doi: 10.1007/s40140-017-0239-0.
    1. Stewart GN. Researches on the Circulation Time and on the Influences which affect it. The Journal of physiology. 1897;22(3):159–183. doi: 10.1113/jphysiol.1897.sp000684.
    1. Pittiruti M, Brutti A, Celentano D, Pomponi M, Biasucci DG, Annetta MG, Scoppettuolo G. Clinical experience with power-injectable PICCs in intensive care patients. Crit Care. 2012;16(1):R21. doi: 10.1186/cc11181.
    1. Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med. 2014;3(4):80–94. doi: 10.5492/wjccm.v3.i4.80.

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