Intravascular Devices in the ICU
Intravascular devices are widely used in the intensive care unit, both for monitoring and access. They may be useful for managing hemodynamics in critically ill patients in order to maintain organ perfusion. This need has prompted the development of several different devices to assist in the assessment of hemodynamic variables. For many years the most common monitor used was the pulmonary artery catheter although several studies have called its utility into question. This has prompted the development of newer, less invasive devices. A monitoring device is only as valuable as the skill of the clinician who is interpreting the data. The decision to place any intravascular monitor must require an assessment of the individual patient as well as a practitioner who is comfortable interpreting the data and applying it to specific treatment algorithms.
KeywordsCentral venous catheter Pulmonary artery catheter Cardiac output monitoring Pulse contour analysis devices
- 6.Bion J, Richardson A, Hibbert P, Beer J, Abrusci T, McCutcheon M, Cassidy J, Eddleston J, Gunning K, Bellingan G, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf. 2013;22(2):110–23.CrossRefGoogle Scholar
- 10.Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005;366(9484):472–7.CrossRefGoogle Scholar
- 12.National Heart L, Blood Institute Acute Respiratory Distress Syndrome Clinical Trials N, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, de Boisblanc B, Connors AF Jr, Hite RD, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.CrossRefGoogle Scholar
- 14.Hoggard J, Saad T, Schon D, Vesely TM, Royer T. Guidelines for venous access in patients with chronic kidney disease. A position statement from the American Society of Diagnostic and Interventional Nephrology Clinical Practice Committee and the Association for Vascular Access. Semin Dial. 2008;21(2):186–91.CrossRefGoogle Scholar