Can "Fluctuation of the Fluid Level" Predict "the Position of the Tip of Central Venous Catheter" ?
Keywords:
venesection, the tip of central venous catheter, radiography, Basilic venous cutdownAbstract
Objective: To determine correlation between the clinical parameter (fluctuation of fluid level) and the position of the tip of central venous catheter.
Design: Prospective, observational study.
Setting: Patients in surgical ward or ICUs at Lerdsin Hospital, Rajvithi Hospital, and Nopparatana Rajathanee Hospital.
Patients: Consecutive patients (n = 80) requiring central venous cannulation.
Intervention: After each basilic venous cutdown, the patients were instructed to have chest radiography. The tip of central venous catheter was assumed to be in proper position if the fluctuation of fluid level reached 4 cm. Actual radiologic findings were subsequently compared against clinical predictions.
Main Outcome Measurements: Ability of the clinical parameter (good fluctuation of fluid level) to correctly predict the position of the tip of central venous catheter.
Results: Good fluctuation of fluid level can be obtained in 90 % of patients. The ability of this clinical parameter to predict the position of the tip of central venous catheter was quite high (94.2% sensitivity, 36.0% specificity, 90.2% positive predictive value, 50.0% negative predictive value).
Conclusion: This parameter is reproducible with high sensitivity, but low specificity. The number of patients may not be enough to draw a decisive conclusion.
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