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Pasion E, Good L, Tizon J, Krieger S, O’Kier C, Taylor N, Johnson J, Horton CM, Peterson M. Evaluation of the monitor cursor-line method for measuring pulmonary artery and central venous pressures. Am J Crit Care 2010; 19:511-21. [PMID: 21041196 DOI: 10.4037/ajcc2010502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine if the monitor cursor-line feature on bedside monitors is accurate for measuring central venous and pulmonary artery pressures in cardiac surgery patients. METHODS Central venous and pulmonary artery pressures were measured via 3 methods (end-expiratory graphic recording, monitor cursor-line display, and monitor digital display) in a convenience sample of postoperative cardiac surgery patients. Pressures were measured twice during both mechanical ventilation and spontaneous breathing. Analysis of variance was used to determine differences between measurement methods and the percentage of monitor pressures that differed by 4 mm Hg or more from the measurement obtained from the graphic recording. Significance level was set at P less than .05. RESULTS Twenty-five patients were studied during mechanical ventilation (50 measurements) and 21 patients during spontaneous breathing (42 measurements). Measurements obtained via the 3 methods did not differ significantly for either type of pressure (P > .05). Graphically recorded pressures and measurements obtained via the monitor cursor-line or digital display methods differed by 4 mm Hg or more in 4% and 6% of measurements, respectively, during mechanical ventilation and 4% and 11%, respectively, during spontaneous breathing. CONCLUSION The monitor cursor-line method for measuring central venous and pulmonary artery pressures may be a reasonable alternative to the end-expiratory graphic recording method in hemodynamically stable, postoperative cardiac surgery patients. Use of the digital display on the bedside monitor may result in larger discrepancies from the graphically recorded pressures than when the cursor-line method is used, particularly in spontaneously breathing patients.
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Affiliation(s)
- Editha Pasion
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Levell Good
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Jisebelle Tizon
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Staci Krieger
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Catherine O’Kier
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Nicole Taylor
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Jennifer Johnson
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Carrie M. Horton
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
| | - Mary Peterson
- Editha Pasion, Levell Good, Jisebelle Tizon, Staci Krieger, Nicole Taylor, and Jennifer Johnson are staff nurses; Catherine O’Kier is a specialty shift coordinator; and Mary Peterson is a clinical educator in the intensive care unit at Exempla St Joseph Hospital in Denver, Colorado. Carrie M. Horton was a clinical nurse specialist in the Cardiovascular Institute at Exempla St Joseph Hospital
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Abstract
Hemodynamic monitoring has become an integral component of the assessment of the critically ill. Any technology used for monitoring is a diagnostic tool and only as good as the provider interpreting the data. The article focuses on providing the practitioner the physiologic basis of the hemodynamic profile to cross the chasm of turning data into clinically useful information. Decision-making models are described to facilitate data synthesis and clinical intervention.
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Affiliation(s)
- Kara L Adams
- Critical Care, University Medical Center, Tucson, AZ 85724, USA.
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Affiliation(s)
- Maureen Keckeisen
- Maureen Keckeisen is a clinical nurse specialist at UCLA Medical Center and assistant clinical professor at the UCLA School of Nursing in Los Angeles, Calif
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Ahrens TS, Schallom L. Comparison of pulmonary artery and central venous pressure waveform measurements via digital and graphic measurement methods. Heart Lung 2001; 30:26-38. [PMID: 11174365 DOI: 10.1067/mhl.2001.112504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Techniques to measure pulmonary artery (PA) pressure waveforms include digital measurement, graphic measurement, and freeze-cursor measurement. Previous studies reported the inaccuracy of digital and freeze-cursor measurements. However, many of the previous studies were small and did not thoroughly examine the circumstances of when digital measurements might be inaccurate. OBJECTIVES To compare digital measurements and graphic measurements of PA and central venous pressure (CVP) waveforms in patients with a variety of respiratory patterns, and to compare digital measurements and graphic measurements of CVPs in patients with abnormal or right ventricular waveforms. METHODS A total of 928 patients were enrolled in this study. Waveforms from the PA and CVP were collected from each patient. The monitor pressure value (digital measurement) printed on the recorded waveform was compared with the pressure value obtained by a graphic strip recording and measured by one of the primary investigators (graphic measurement). RESULTS Digital measurements were found to be inaccurate in measuring waveforms in all respiratory categories and in measuring right ventricular waveforms. PA diastolic values and CVP values were the most inaccurately measured waveforms. Digital errors of more than 4 mm Hg were common. CONCLUSION There were instances in which the monitor's digital measurement was substantially different from the graphically measured value. This difference has the potential to mislead interpretation of clinical situations. The monitor's ability to occasionally give digital measurement values similar to the graphic measurements may lead to a false sense of security in clinicians. Because the accuracy of the monitor is inconsistent, the bedside clinician should interpret waveforms through use of a graphic recording rather than rely on the digital measurement on the monitor.
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Affiliation(s)
- T S Ahrens
- Critical Care Units, Barnes-Jewish Hospital, One Barnes Hospital Plaza, St Louis, MO 63110, USA
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