Issues in Cardiac CareComparison of pulmonary artery and central venous pressure waveform measurements via digital and graphic measurement methods☆,☆☆
Section snippets
Current issues in measuring pressure values
The bedside clinician, (eg, nurse) can obtain pressure measurements through 1 of 3 Methods: (1) reading waveform values directly from the monitor (digital measurement); (2) measuring the waveform directly from a printed copy of the wave (graphic measurement); and (3) using the freeze-cursor function on the bedside monitor. Based on the research that suggests that digital measurements may be inaccurate, the best options are the second and third methods.
Bedside monitor programs use filtering
Study questions
To consider the issue of the accuracy of bedside monitoring, the following questions are addressed.
- 1.
What are the differences between those PA and CVP pressure waveform measurements obtained through digital measurement and those obtained through graphic measurement?
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Does respiratory rate or the mode of mechanical ventilation affect the accuracy of PA and CVP waveform measurements obtained through digital or graphic measurements?
- 3.
Are there differences between the CVP waveform measurements obtained
Methods
The study was conducted at 3 community and 2 university hospitals between 1995 and 1998. The Human Subjects Committee at Washington University approved an expedited review of the study. Data collection involved obtaining a monitor strip from any patient with a PA catheter in place. Neither subjects’ names nor any other identifying characteristics were collected as part of the study.
Sample description
During the measurement period, 928 patients were enrolled in the study and 965 measurements were obtained. All patients were from adult critical care units with surgical, cardiac-surgical, cardiac-medical, or general-medical admitting diagnoses. The total sample size and the sample size of each of the respiratory categories for each manufacturer are presented in Table I.Company Total sample size SB < 20 breaths/min SB > 20/min VB only VB + SB < 20/min VB + SB > 20/min Abnormal and RV
Discussion
The answers to the 3 research questions are consistent with previous research that indicates that digital display measurements have limited accuracy. In several circumstances, the differences between digital and graphic measurement were of clinical importance. For at least 1 value (PAS, PAD, or CVP) in each respiratory category, a statistically significant difference between the digital measurement and graphic measurement values was present (Table II). The Wilcoxon matched pairs signed-rank
Conclusion
Use of graphic recordings as the gold standard must continue despite improvements in digital engineering. Clearly, errors occur with all monitors’ digital measurements in all respiratory and abnormal waveform patterns. Monitor program design excludes correct measurement of waveforms such as RV or abnormal venous waves. Some of the digital measurement errors are not clinically important. However, when the errors are clinically important, the only protection for the patient is the bedside
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Cited by (14)
Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients
2017, British Journal of AnaesthesiaCitation Excerpt :However, this technique requires an oesophageal probe that is not used in daily practice. Second, even if CVPMONITOR was greater than CVPCALCULATED of CVPNADIR in 94/103 CVP assessments (91%), the tracing of CVP on the monitor should be checked for diagnosing a potential anomaly.7 Tricuspid regurgitation or a deeper insertion with intra-ventricular pressure could indeed impair the value of CVPMONITOR.15
Pulmonary hypertension related to left heart disease: Insight from a wireless implantable hemodynamic monitor
2015, Journal of Heart and Lung TransplantationCitation Excerpt :Indeed, our study has shown that the patients with a “mixed” phenotype of PH with elevated wedge pressure and PVR >3 Wood units or TPG >15 mm Hg had the highest annual hospitalization rates. Although RHC remains the definitive “gold standard” for assessing the hemodynamic profile of patients with PH, the approach has some limitations.17,18 These measurements are often performed under artificial conditions while patients are at rest and may not reflect the true extent of hemodynamic compromise.
Narrative history of the swan-ganz catheter: Development, education, controversies, and clinician acumen
2020, AACN Advanced Critical CareCitation Excerpt :In addition, if nurses do not know how to properly interpret waveforms, small interpretation errors can result in clinical decisions based on erroneous data. Graphic printouts illustrate that even a small mistake can change a wedge pressure from normal to abnormal.26 Fortunately, resources describing medication therapy based on PAC values have vastly improved.
Twelve-month follow-up results from the SIRONA 2 clinical trial
2024, ESC Heart FailureAACN practice alert: Pulmonary Artery/central venous pressure monitoring in adults
2020, AACN Advanced Critical CarePulmonary artery/central venous pressure monitoring in adults
2016, Critical Care Nurse
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Supported by the St Louis chapter of AACN, Marquette Electronics, and Mennen Medical.
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Reprint requests: Thomas S. Ahrens, DNS, RN, CCRN, CS, Nursing Service Barnes-Jewish Hospital, One Barnes Hospital Plaza, St Louis, MO 63110.