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Peripheral venous pressure predicts central venous pressure poorly in pediatric patients

[La tension veineuse périphérique est un reflet imprécis de la tension veineuse centrale chez les enfants]

Carl C.P. Leipoldt, MB ChB^*, William P.S. McKay, MD^*, Michelle Clunie, MD^* and Grant Miller, MD

^* From the Departments of Anesthesia and
Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Address correspondence to: Dr. William P.S. McKay, Research Director and Deputy Head, Department of Anesthesia, University of Saskatchewan, RUH, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. Phone: 306-655-1202; Fax: 306-655-1279; E-mail: william.mckay{at}saskatoonhealthregion.ca

Purpose: Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a volume monitor decreases patient risks and costs, and is convenient. This study was undertaken to determine if PVP predicts CVP in pediatric patients.

Methods: With ethical approval and informed consent, 30 pediatric patients aged neonate to 12 yr requiring a central venous line were studied prospectively in a tertiary care teaching hospital. In the supine position, PVP and CVP were simultaneously transduced. Ninety-six paired recordings of CVP and PVP were made. Correlation and Bland-Altman analysis of agreement of end-expiratory measurements were performed.

Results: The mean (SD; range) CVP was 10.0 mmHg (6.0; –1.0 to 27.0); the mean PVP was 13.7 mmHg (6.3; 0.0 to 33.0); offset (bias) of PVP > CVP was 3.7 mmHg with SD 2.6. The 95% confidence intervals (CI) for the bias were 3.2 to 4.1 mmHg. In the Bland-Altman analysis, lower and upper limits of agreement (LOA; CI in parentheses) were –1.5 (–2.3 to –0.7) and 8.8 (8.1 to 9.6) mmHg. Eight of 96 points were outside the limits of agreement. The correlation of PVP on CVP was r = 0.92, P < 0.0001. For a subset of ten patients (20 simultaneous recordings) with iv catheters proximal to the hand, limits of agreement were better - offset: 3.8 mmHg (± 1.4); lower LOA: 1.2 mmHg (0.25 to 2.1); upper LOA: 6.6 mmHg (5.7 to 7.5).

Conclusion: Peripheral venous pressure measured from an iv catheter in the hand predicts CVP poorly in pediatric patients.