A Study of the Differences in Central Venous Pressure Between the Distal Lumen and Proximal Lumen of Central Venous Catheters in Pediatric Patients.

BACKGROUND

The choice of a central venous catheter (CVC) lumen to connect the central venous pressure (CVP) measurement line varies by facility. However, if the CVP values differ based on the connected CVC lumen, this variation could significantly affect the interpretation of the CVP measurements, raising major concerns regarding circulatory management of the patient.

AIMS: This study aimed to determine whether a difference exists in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients undergoing cardiac surgery.

METHODS

Seventeen pediatric patients with congenital heart disease, aged 1 to 31 months, who underwent cardiac surgery between November 2022 and November 2023, were included in this study. The CVC was inserted via the right internal jugular vein or right supraclavicular approach. Separate transducers were connected to the proximal and distal lumens. The CVP values from each were recorded simultaneously throughout the surgery. Differences were examined in the following phases: (1) after general anesthesia induction, (2) after initiation of cardiopulmonary bypass (CPB), and (3) after weaning from CPB.

RESULTS

No statistically significant differences were observed in A-wave pressure, X-descent pressure, or mean CVP values measured from the distal and proximal lumens after general anesthesia induction or after weaning from CPB. The distal lumen showed significantly lower pressure than the proximal lumen after CPB initiation.

CONCLUSIONS

Our findings revealed no significant difference in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients; moreover, the proximal lumen provided reliable CVP values, even during CPB. These findings support connecting the CVP line to the proximal lumen, offering the great advantage of early detection of CVC slippage through changes in the CVP values and waveforms.

TRIAL REGISTRATION: This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000052944).