Advertisement

Monitoring arterial, central venous and pulmonary capillary wedge pressure

      Abstract

      Arterial blood pressure can be monitored non-invasively by mercury manometer, automated oscillotonometer or continuously by a Finapres based on the Penaz technique. Insertion of a cannula into an artery allows continuous beat-to-beat blood pressure monitoring with pressure transmitted along a column of saline to a piezo-resistive strain gauge transducer. Continuously monitoring blood pressure aids optimization of adequate organ perfusion and further information gained from the waveform can be used to guide treatments. Central venous pressure is the pressure within the right atrium and great veins of the thorax. In a healthy adult, it is between 0 and 8 cm H2O, varying with respiration. It is measured via a cannula inserted into the superior vena cava (usually via internal jugular or subclavian veins) and uses a pressurized transducer set to produce a reading of central venous pressure and venous waveform. Venous bloods and central venous gases can also be taken and drugs and infusions (particularly if irritant) can be administered. Serial readings are useful for assessing progress and response to treatment. Pulmonary capillary wedge pressure represents left atrial filling pressure and therefore left ventricular end-diastolic pressure and allows more accurate assessment of left-sided heart function. It is measured by floating a pulmonary artery catheter and wedging a balloon into a pulmonary artery branch. It has a complication rate of 10% and, as studies have shown it to have no clear evidence of benefit, alternative less invasive methods such as oesophageal Doppler or arterial pulse contour analysis are now common alternatives.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Anaesthesia & Intensive Care Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Medicines and Healthcare products Regulatory Agency
        Report of the independent advisory group on blood pressure monitoring in clinical practice.
        (Available from:) (accessed 15.10.2008)
        • Lin C.C.
        • Jawan B.
        • de Villa M.V.
        • et al.
        Blood pressure cuff compression injury of the radial nerve.
        J Clin Anesth. 2001; 13: 306-308
        • Medicines Information (UKMi)
        Questions & answers: should heparin based flushing solutions be used in preference to saline to maintain the patency of indwelling intravascular catheters and cannulae?.
        UKMi, London2008 (Available from:) (accessed 15.10.2008)
        • Husum B.
        • Berthelsen P.
        Allen’s test and systolic arterial pressure in the thumb.
        Br J Anaesth. 1981; 53: 635-637
        • National Patient Safety Agency
        Supporting information for Rapid Response Report NPSA/2008/RRR06. Problems with infusions and sampling from arterial lines.
        (Available from:) (accessed 15.10.2008)
        • National Patient Safety Agency
        Rapid Response Report, NPSA/2008/RRR006, 28.
        (Problems with infusions and sampling from arterial lines. Available from:) (accessed 15.10.2008)
        • Maki D.G.
        • Kluger D.M.
        • Crnich C.J.
        The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.
        Mayo Clin Proc. 2006; 81: 1159-1171
        • Eisen L.A.
        • Narasimhan M.
        • Berger J.S.
        • et al.
        Mechanical complications of central venous catheters.
        J Intensive Care Med. 2006; 21: 40-46
        • Hind D.
        • Calvert N.
        • McWilliams R.
        • et al.
        Ultrasonic locating devices for central venous cannulation: meta-analysis.
        BMJ. 2003; 327: 361-368
        • Pratt R.J.
        • Pellowe C.M.
        • Wilson J.A.
        • et al.
        Epic2 guidelines.
        J Hosp Infect. 2007; 655: 51-64
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2006; 355: 2725-2732
        • Saving Lives
        High impact interventions number 1. Central venous catheter care bundle.
        (Available from:) (accessed 15.10.2008)
        • Connors Jr., A.F.
        • Speroff T.
        • Dawson N.V.
        • et al.
        The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.
        JAMA. 1996; 276: 889-897
        • Sandham J.D.
        • Hull R.D.
        • Brant R.F.
        • et al.
        A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.
        N Engl J Med. 2003; 348: 5-14
        • Harvey S.
        • Harrison D.A.
        • Singer M.
        • et al.
        Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.
        Lancet. 2005; 366: 472-477