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

Abstract

Background: Unlike its use during stable conditions, central venous pressure (CVP) monitoring from a peripherally inserted central venous catheter (PICC) has not often been used in surgeries with significant hemodynamic alterations. The aim of this study was to evaluate the feasibility of measuring PICC pressure (PICCP) as an alternative to measuring centrally inserted central catheter pressure (CICCP) in adult liver transplantation (LT) patients.

Methods: We measured PICCP and CICCP simultaneously during each main surgical period in adult LT. Statistical analysis was performed using simple linear regression analysis to observe whether changes in PICCP paralleled by simultaneous changes in CICCP. Correlation analysis and Bland-Altman analysis were used to determine the degree of agreement between the two devices. Differences were considered statistically significant when P values were less than 0.05.

Results: A total of 1342 data pairs were collected from 35 patients. The PICCPs and CICCPs were highly correlated overall (r = 0.970, P < 0.001) as well as at each period measured. The differences among each period were not clinically significant (0.33 mmHg for pre-anhepatic, 0.32 mmHg for anhepatic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic periods). The overall mean difference was 0.14 mmHg (95% confidence interval: 0.09-0.19) and PICCP tended to give a higher reading by between 0.09 and 0.19 mmHg overall. The limit of agreement was -1.74 to 2.02 overall.

Conclusions: These findings suggest that PICCP can be a reasonable alternative to CICCP in situations of dynamic systemic compliance and preload, as well as under stable hemodynamic conditions.

Keywords: CVP; Liver transplantation; Peripherally inserted central catheter pressure.

Fig. 1

Linear regression analysis plot of PICCP and CICCP for all data pairs with Pearson's correlation coefficient (r = 0.970, P < 0.001). CICCP: centrally inserted central catheter pressure, PICCP: peripherally inserted central catheter pressure.

Fig. 2

Bland-Altman plot for all data pairs with calculation of bias and precision. The solid horizontal line represents the mean bias between the two devices. The two dashed horizontal lines represent the mean bias ± 1.96 times the standard deviation of the differences. CICCP: centrally inserted central catheter pressure, PICCP: peripherally inserted central catheter pressure.

Fig. 3

Bland-Altman plot for each surgical period with calculation of bias and precision. (A) Bland-Altman plot for data points collected during preanhepatic period. (B) Bland-Altman plot for data points collected during anhepatic period. (C) Bland-Altman plot for data points collected during reperfusion period. (D) Bland-Altman plot for data points collected during neohepatic period. The solid horizontal line represents the mean bias between the two devices. The two dashed horizontal lines represent the mean bias ± 1.96 times the standard deviation of the differences. CICCP: centrally inserted central catheter pressure, PICCP: peripherally inserted central catheter pressure.