Measurement of cardiac output by transpulmonary arterial thermodilution using a long radial artery catheter. A comparison with intermittent pulmonary artery thermodilution

Abstract

Cardiac output can be measured accurately by transpulmonary arterial thermodilution using the PiCCO (Pulsion Medical Systems, Munich, Germany) system with a femoral artery catheter. We have investigated the accuracy of a new 50 cm 4 French gauge radial artery catheter and the ability to use the system with a shorter radial catheter. We studied 18 patients who had undergone coronary artery surgery and made three simultaneous measurements of cardiac output by arterial thermodilution and with a pulmonary artery catheter. The radial catheter was withdrawn in 5 cm increments and the measurements were repeated. We found close agreement between arterial thermodilution and pulmonary artery thermodilution with a mean (SD) bias of 0.38 (0.77) l x min(-1). Arterial thermodilution became unreliable once the catheter had been withdrawn by more than 5 cm. We conclude that cardiac output measurement with arterial thermodilution with a radial catheter is interchangeable with that derived from a pulmonary artery catheter, and that a centrally sited arterial catheter is required for accurate determination of cardiac output by transpulmonary arterial thermodilution.

Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement

“…This is the first prospective observational study that evaluates upper limb blood flow by Doppler ultrasound, more than 45 days after placement of the long radial PiCCO™ catheter in critically ill patients. When we insert arterial catheters from the PiCCO™ system (for advanced hemodynamic monitoring), the femoral artery is the preferred site, although the radial approach is also validated [ 4 ], using arterial catheters which are longer (50 cm) and of higher diameter (4 Fr) than conventional short catheters.…”

“…This additional feature slightly increases the diameter compared to a conventional arterial line, being the main reason to prefer femoral arterial access. Despite this, TPTD has also been validated using a special catheter via the radial artery approach [ 4 ]. This catheter is 50 cm long in order to reach the subclavian artery and receive a true reflection of central aortic pressure [ 5 ].…”