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Schumz

Central venous pressure monitoring

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Guys I need your expertise and knowledge about use of CVP monitoring in a sick neonate... The normal values range in between 4-6 in children (as per the literature...)

How much do we rely on this measurement? Are there any normal values in preterm infants or non-immune hydrop babies? 

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In my experience CVP is much more helpful as a trend - if I plug in the transducer and it says 8 vs 6, I'm not sure I know what that means.  But if it was 8 all day and now it is 6 or 4, I can go looking for a reason for the change or a consequence of that change.  If I'm looking for numbers to target early in the course and I'm worried about preload status, I'd much rather know targeted echo (if available at your facility) and/or pH and lactates.  

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18 hours ago, bimalc said:

In my experience CVP is much more helpful as a trend - if I plug in the transducer and it says 8 vs 6, I'm not sure I know what that means.  But if it was 8 all day and now it is 6 or 4, I can go looking for a reason for the change or a consequence of that change.  If I'm looking for numbers to target early in the course and I'm worried about preload status, I'd much rather know targeted echo (if available at your facility) and/or pH and lactates.  

@bimalc thanks for your reply. Yes we have the facility to do Echo in our unit but in a sick infant I was wonedring if it is of some use when monitoring continuously. I agree with you trend rather than spot check is required. The normal values for neonates only studied in 2 studies 1992 by Skinner and another one in 1980 which quote a range from 4-6 for healthy term infants. Most (49/62)babies studied by Skinner had a congenital heart disease and rest had RDS..it was an interesting read :)

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It may or may not be applicable, but if you're setting out to use CVP monitoring in sick neonates, it might also be helpful to think about what things might change the CVP (other than what you're trying to measure).  There is a robust literature in adults (and older children) looking at the effects of high PEEP etc. on CVP readings.  I haven't looked at it in a number of years, but if I was going to start transducing CVPs regularly and getting calls from nurses or house staff about shifts, I'd probably want to have a mental list of all the iatrogenic things that can and cannot change the value of a CVP reading.

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https://lifeinthefastlane.com/ccc/cvp-measurement/ I have mixed feelings in LITFL as they often just make a series of statements and then list some references at the end (as opposed to indicating in the text what evidence there is for each claim) but for this particular discussion, it seems like a reasonable starting point.

I could caution that, as we always are, we remain skeptical about the extrapolation of this data to neonates (on the other hand, for many of these issues there is no neonatal data so one must start someplace).  

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