Central Venous Pressure Clinical Trial
Official title:
A Prospective, Comparative Study to Evaluate the Accuracy of a Non-Invasive Central Venous Pressure Method to the Standard CVP Method
This is a prospective, comparative, internally controlled device study that will enroll a total of 100 adult patients that require the placement of central venous catheter and CVP monitoring to assess volume status and cardiac preload.
Standard CVP Method
The CVP line is inserted into the internal jugular vein central venous catheter or subclavian
vein catheter and threaded to the point where the superior vena cava meets the inferior vena
cava prior to entry into the right atrium of the heart. The catheter is hooked to a pressure
bag which is pressurized to 200 cm water. This pressure allows the infusion of about 3ml of
fluid each hour but keeps the line patent. The distal tip of the CVP line is connected to a
transducer and taped to the arm at a level which is in line with the heart.
Research Procedure (non-invasive CVP Method)
A physiologic data acquisition system (Zoe Medical, Topsfield MA)) will be used to monitor
CVP, upper arm impedance changes, and upper arm cuff pressures.
The subject's CVP pressure transducer will be zeroed at the level of the right atrium
(midaxillary line) with the use of a carpenter's level.
A tetra-polar impedance configuration will be used to measure upper arm impedance. A pair of
current-injecting electrodes will be placed in positions 1 & 4 and two sensing electrodes
will be placed in positions 2 & 3 (where a traditional blood pressure cuff would be
positioned, overlying the brachial-axillary vein system). These leads extend from the Zoe
Medical device. (Figure 1 taken from Ward et al., in press).
Electrobioimpedance will be measured in the upper portion of an upper extremity using an
electrobioimpedance amplifier contained within the Zoe Medical device. A constant current
source (1mA, 100kHz) will be sent through the current electrode and the voltage drop between
the two sensing electrodes will be amplified.
A blood pressure cuff attached to the Zoe Medical Device will be positioned over the two
sensing electrodes.
The cuff pressure will be quickly inflated to a value higher than CVP but lower than the
diastolic arterial pressure (40 mm Hg) and kept at that pressure for 45-60 seconds.
At the end of the inflation hold period, release the cuff pressure valve and open to
atmosphere to allow rapid self-deflation
Repeat measures 3 times in each subject for a period of 10 minutes
If the subject requires volume resuscitation, diuresis, or are administered inotropic drugs,
we will reevaluate CVP with the non-invasive method during these circumstances. CVP will be
measured every 1 minute to capture rapid changes in CVP. The length of time that the
investigators monitor CVP will depend on the length of time required to detect changes in
CVP.
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