(141) Comparing Midline Versus Central Line Venous Pressures: Is This a New Tool in Resuscitation?

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 04

First Author(s)

Brendan Sweeney, BS (he/him/his)

USA

Co-Author(s)

Justin Kim, ACNP, MSN (he/him/his)

Nurse Practitioner
George Washington University Hospital, United States
AA

Ariana Adnani, BA

Medical Student
George Washington University SMHS, United States
MW

Maria Wu, BA

Medical Student
George Washington University SMHS, United States
RB

Rishika Bheem, BA

Medical Student
George Washington University SMHS, United States
HS

Huma Saleem, MD

Research Coordinator
n/a, United States
SA

Seda Akben, M.D

Physician
George Washington MFA, United States
MR

Michael Roth, MS

Medical Student
Medical College of Wisconsin, United States
YT

Yin Rong Alvina Teo, RN

Registered Nurse
George Washington University Hospital, United States
Eduard Shaykhinurov, MS

Washington, District of Columbia, USA
Danielle Davison, MD

Associate Professor, Director of Intensive Care
George Washington University Medical Center
Washington, District of Columbia, United States
KH

Katrina Hawkins, MD

Associate Professor of Anesthesiology and Critical Care Medicine
George Washington University, United States
DK

Daniel King, MD

Assistant Professor
George Washington University Hospital, United States
SI

Samita Islam, BS

Medical Student
George Washington University SMHS, United States
DY

David Yamane, MD,

Associate Professor
George Washington University, District of Columbia, United States
SI

Sasa Ivanovics, MD

Physician
George Washington University
Newtown, Connecticut, United States

Introduction: Midline catheters (ML) are long peripheral intravenous catheters placed in an upper extremity above the antecubital fossa via the basilic, cephalic, or brachial veins. These provide safe and comfortable long-term vascular access for critically ill patients. Central venous pressures (CVP) are obtained from central venous catheters (CVC) and are often used as resuscitation parameters. Given the proximity of ML to the axillary vein, we set out to see if the midline venous pressure (MVP) is comparable to the CVP.

Methods: This is an observational study conducted in adult critical care patients at a tertiary academic center. Inclusion criteria were patients with a CVC in the internal jugular or subclavian vein and a ML in an upper extremity as part of standard ICU care. Using a standard pressure measuring system, venous pressure measurements were recorded from both catheters every 15 minutes over a 60-minute period. Demographic, clinical, and physiological data points were collected. Continuous variables were analyzed using the t-test. Pearson correlation was used to evaluate the relationship between the paired variables.

Results: In our analysis, we enrolled a total of 48 patients with 5 pressure measurements taken per patient (n = 240). The average patient age was 57.9 +/- 16.1 years. The mean SOFA and APACHE II scores were 8.3 +/- 3.7 and 19.2 +/- 7.8, respectively. The mean MVP and CVP were 10.8 +/- 6.3 mmHg and 9.4 +/- 6.3 mmHg, respectively (p < 0.001). In the Bland Altman analysis, the mean bias was -1.45 +/- 4.07 mmHg with limits of agreement of -9.4 mmHg to 6.5 mmHg. The Pearson correlation coefficient was found to be 0.8 (p < 0.001).

Conclusions: In our study, the use of MVP as a correlate of CVP was investigated. Our results show a mean bias of -1.45 +/- 4.07 mmHg and a strong positive Pearson correlation coefficient of 0.8 between the MVP and the CVP. Despite this, the large limits of agreement indicate MVP and CVP are not interchangeable.