CVP And PowerPICC

[NerdyRN]

There was a recent discussion in our ICU when we received an order for CVP monitoring.

there are reports, although I'm not certain the origin, that the valved structure of the "Bard Purple PowerPICC" will skew the results of your pt's CVP.

Has anyone had first hand experience with this, or know of any ways to minimize that variance.

Does leaving the Positive pressure caps in place help or hinder?

The waveform looked normal once monitoring was established, and demonstrated a CVP around 20 which was expected for how overloaded they appeared.

My Question come down to this; even if the circut is appropratly zeroed and balanced, can this number be trusted?

[PDX_RN]

According to Bard, the power picc is indicated for monitoring CVP (http://www.bardaccess.com/powerpicc//faq.php). I think it is the Groshong PICC that can potentially dampen the CVP waveform. However, perhaps an even more important consideration is whether or not the CVP is a reliable indicator of fluid status. Here is a reference to a recent review article that debates the reliabilty of CVP monitoring for assessing fluid status.

Marik, P. E., Baram, M., & Vahid, B. (2008). Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 134(1), 172-178. doi: 10.1378/chest.07-2331.

http://chestjournal.chestpubs.org/content/134/1/172.full

[NtannRN]

At my facility, we do not use any Picc lines for CVP monitoring. The site just lists that you can use it for cvp monitoring but does not give any kind of special instructions.