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Is the central venous pressure reading equally reliable if the central line is inserted via the femoral vein
  1. Joel Desmond, RCS Research Fellow,
  2. Mahmoud Megahed, Specialist Registrar
  1. Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether femoral central venous lines were as reliable as subclavian or jugular lines at assessing right atrial filling pressure. Altogether 141 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Joel Desmond,RCS Research FellowChecked by Mahmoud Megahed, Specialist Registrar

    Clinical scenario

    You have been called to the resuscitation room to see a 67 year old woman who has walked out in front of a bus while shopping in town. She has an obvious closed fracture of her left arm and she is complaining of abdominal pain and central neck pain. You elicit from her husband that she has had two heart attacks in the past and the drugs in her handbag are bendrofluazide, frumil, and lisinopril. Her blood pressure is 90/52 and her pulse is 105. You are concerned that she may be hypovolaemic, but you are aware of the dangers of giving too much fluid to a patient with probable heart failure. You elect to insert a central line for central venous pressure monitoring but she has a neck collar on and so you wonder if placing this via the femoral vein would affect your readings.

    Three part question

    In [patients requiring central venous pressure monitoring] is [a femoral vein central line as good as a jugular or subclavian line] at [reliability assessing right atrial filling pressure]?

    Search strategy

    Medline 1966–06/03 using the OVID interface. [(exp Central Venous Pressure OR Central Venous pressure.mp) AND (exp Vena Cava, Inferior OR vena cava.mp)] LIMIT to human.

    Search outcome

    Altogether 141 papers of which nine were found to be relevant. These papers are shown in table 5.

    Table 5

    Comment(s)

    There is extensive and consistent evidence that right atrial pressure can be reliably measured using both inferior vena cava and common iliac venous pressure measurements in supine patients. This has been proved in ventilated and spontaneously breathing adults and children. The readings of inferior vena caval measured pressures seem to be around 0.5 mm Hg lower than superior vena caval measured pressure on average and rarely more than 3 mm Hg different. This may not apply to patients with raised intra-abdominal pressure but applies to patients with high PEEP or raised mean airway pressures.

    CLINICAL BOTTOM LINE

    Inferior vena caval or common iliac venous pressure can be used reliably to measure right atrial pressure and may be regarded as equivalent to readings of superior vena caval pressure.

    Report by Joel Desmond,RCS Research FellowChecked by Mahmoud Megahed, Specialist Registrar

    References

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