Can peripheral venous pressure be an alternative to central venous pressure during right hepatectomy in living donors?

Abstract

The safety of living donors is a matter of cardinal importance in addition to obtaining optimal liver grafts to be transplanted. Central venous pressure (CVP) is known to have significant correlation with the amount of bleeding during parenchymal transection and many centers have adopted CVP monitoring for right hepatectomy. However, central line cannulation can induce some serious complications. Peripheral venous pressure (PVP) has been suggested as a comparable alternative to CVP. The aim of this study was to determine whether a clinically acceptable agreement or a reliable correlation between CVP and PVP exist and if CVP can be replaced by PVP in living liver donors. A central venous catheter was placed through the right internal jugular vein and a peripheral venous catheter was inserted at antecubital fossa in the right arm. CVP and PVP were recorded in 15-minunte intervals in 50 adult living donors. The paired data were divided into 3 stages: preparenchymal transection, parenchymal transection, and postparenchymal transection. A total of 1,430 simultaneous measurements of CVP and PVP were recorded. Overall, the PVP, CVP, and bias were 7.0 Ϯ 2.46, 5.9 Ϯ 2.32, and 1.16 Ϯ 1.12 mmHg, respectively. A total of 88.9% of all measurements were clinically within acceptable limits of bias (Ϯ2 mmHg). Regression analysis showed a high correlation coefficient between PVP and CVP (r ϭ 0.893; P Ͻ 0.001) and the limits of agreement were Ϫ1.03 to 3.34 overall. In conclusion, frequencies of differences, bias, correlation coefficient, and limits of agreement between PVP and CVP remained relatively constant throughout the operation. Therefore, PVP measurement in the arm can be an alternative to predict CVP and further, obviate central venous catheter-related complications in living liver donors.

Peripheral Venous Pressure as a Predictor of Central Venous Pressure during Neurosurgical Procedures

“…Recently, however, numerous studies have reported a strong correlation between CVP and PVP in various surgeries. [3,10,12,13,15,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] As in other studies, we found a consistently higher value for PVP than for CVP. The mean difference of approximately 4mm Hg likely represents peripheral venous resistance upstream from the vena cava.…”

“…[11] Previously, some clinicians have introduced PVP, a simple and less invasive hemodynamic monitoring variable, as an alternative to CVP and found various correlations between them. [16,[18][19][20][21][22][23][24] PVP instead of CVP has not been widely advocated in the past because peripheral veins have valves that may interrupt the continuous column of blood and are thin walled, and may be more easily subjected to compression and occlusion. In addition, external compression by the operator or blood pressure cuff and overstretching in the catheterized arm can occlude the peripheral vein and increase PVP.…”

Non-invasive central venous pressure measurement by compression ultrasound—A step into real life

“…Several studies employing invasive and non invasive techniques showed a good correlation between peripheral venous pressure and CVP under a variety of study conditions in the operating room and the intensive care unit. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Basis for these studies is the fact, that in supine position pressure values within the cephalic, basilic and brachial veins are nearly identical to those of the superior vena cava. 4,5,19 Measurements of the inferior vena cava (IVC) diameter using ultrasound is frequently used to assess volume status of critically ill patients 20,21 , primarily distinguishing hypo-from iso-and hypervolemic conditions.…”

Correlation Between Centrally Versus Peripherally Transduced Venous Pressure in Prone Patients Undergoing Posterior Spine Surgery

“…In view of a variety of potential complications associated with the placement of required central venous lines, including pneumothorax, 2 line infection 3 and vascular damage, 4 a number of authors have suggested the use of peripherally transduced pressures (PVP) instead, based on the correlation found between CVP and PVP. [5][6][7][8] Although this correlation has been well studied in a variety of surgical settings, data confirming the validity of this technique for the purpose of intravascular fluid volume monitoring in prone patients undergoing spine surgery remain scarce. 6,9 Further, because of the impact of the prone position on the cardiovascular system, existing data may not be extrapolated to this patient population.…”