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ZJUS-B
Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology)  2016, Vol. 17 Issue (1): 60-66    DOI: 10.1631/jzus.B1500167
Article     
Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables
Wen-qiao Yu1,?(),Yun Zhang1,Shao-yang Zhang1,Zhong-yan Liang2,Shui-qiao Fu1,Jia Xu3,Ting-bo Liang1,?()
Department of Hepatobiliary and Pancreatic Surgery and Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310021, China
Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
Department of Emergency, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Abstract  

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.

Key words： Transpulmonary thermodilution      Jugular vein catheter      Misplaced subclavian vein catheter      Severe acute pancreatitis     
Received: 09 July 2015      Published: 01 January 2016
Fund:  Project supported by the National Natural Science Foundation of China(Nos. 81501644, 81471623, 81130007, 81270446, 30801188);the Key Science and Technology Innovation Team Project of the Science and Technology Department of Zhejiang Province, China(No. 2011R50018-16)
Corresponding Authors: Wen-qiao Yu,Ting-bo Liang     E-mail: yuwenqiao_60@hotmail.com;liangtingbo@zju.edu.cn
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Wen-qiao Yu
Yun Zhang
Shao-yang Zhang
Zhong-yan Liang
Shui-qiao Fu
Jia Xu
Ting-bo Liang
Cite this article:

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. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology), 2016, 17(1): 60-66.

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http://www.zjujournals.com/xueshu/zjus-b/10.1631/jzus.B1500167     OR     http://www.zjujournals.com/xueshu/zjus-b/Y2016/V17/I1/60

Fig. 1 (a) Subclavian vein catheter was misplaced into internal jugular vein (arrow); (b) jugular vein catheter was replaced (arrow)
Characteristics Value*
Sex (male:female) 8:5
Age (year) 55.3±14.4 (31.0–79.0)
Weight (kg) 73.6±10.4 (58.5–95.0)
Height (cm) 175.5±5.3 (167.0–184.0)
Body surface area (m2) 1.81±0.18 (1.48–2.13)
Body mass index (kg/m2) 16.47±4.20 (13.28–27.93)
APACHE II score 16.69±5.07 (9.00–25.00)
Organ failure
?Acute respiratory distress syndrome 12 (92.3%)
?Acute kidney injury 6 (46.2%)
?Shock 5 (38.5%)
?Abdominal compartment syndrome 6 (46.2%)
ICU survival 12 (92.3%)
Table 1 Characteristics of the patients
Characteristics Value*
Heart rate (beats/min) 102.8±17.1 (78.0–141.0)
Mean arterial pressure (mmHg) 66.7±8.1 (55.0–82.0)
CVPIJV (mmHg) 15.2±5.4 (7.0–26.0)
CVPSCV-IJV (mmHg) 14.5±5.6 (5.0–25.0)
CVPAVG (mmHg) 14.8±5.3 (5.0–26.0)
CIIJV (L/(min·m2)) 3.52±0.98 (1.70–5.60)
CISCV-IJV (L/(min·m2)) 3.69±0.92 (1.80–5.50)
CIAVG (L/(min·m2)) 3.60±0.95 (1.70–5.60)
EVLWIIJV (ml/kg) 10.26±5.23 (3.00–20.00)
EVLWISCV-IJV (ml/kg) 10.43±5.19 (4.00–21.00)
EVLWIAVG (ml/kg) 10.34±5.18 (3.00–21.00)
GEDVIIJV (ml/m2) 796.4±235.1 (432.0–1310.0)
GEDVISCV-IJV (ml/m2) 907.8±266.2 (498.0–1484.0)
GEDVIAVG (ml/m2) 852.1±256.1 (432.0–1484.0)
Table 2 Patients’ cardiopulmonary characteristics
Fig. 2 Transpulmonary thermodilution after jugular (GEDVIIJV, CIIJV, EVLWIIJV) and misplaced access (GEDVISCV-IJV, CISCV-IJV, EVLWISCV-IJV) injection: Bland-Altman analysis of global end-diastolic volume index (a), cardiac output index (b), and extra-vascular lung water index (c) The solid lines indicate the mean difference between variables after jugular and misplaced access injection. The dotted lines indicate the 95% limits of agreement (±2SD)
Fig. 3 Statistical comparison of mean transit time (a), down-slope time (b), and area under the curve (c) after jugular and misplaced access injection
Fig. 4 Superior vena cava catheter position of misplaced subclavian vein catheter (a) and internal jugular vein catheter (b) Blue line in (a) indicates the longer distance of cold saline via the misplaced catheter (Note: for interpretation of the references to color in this figure legend, the reader is referred to the web version of this article)
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