Institutional Review Board, Hospital for Special Surgery
May 11, 2010
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Measuring central venous pressure (CVP) is widely considered a useful aid in the management of a patient’s fluid status during surgery. Usually, the placement of a central venous line is required, which is associated with a number of risks including line infection, vessel injury, accidental carotid puncture and pneumothorax. In addition, placing a central line can be technically difficult or impossible, especially intraoperatively, when patient access is limited by surgical drapes. A number of studies have suggested that peripherally transduced venous pressures (PVP) correlate well with centrally derived values and thus could be used interchangeably. However, information on the feasibility of this technique in the perioperative period, effect on patient comfort, cost and complications is extremely limited. In view of the usefulness of information provided by the measurement of venous pressure in large blood loss/fluid shift cases, such as spine surgical procedures, it seems prudent to study the correlation between CVP and PVP in this population. We propose to measure centrally and peripherally transduced venous pressure in 220 patients undergoing spine surgery in the prone position. The patients would be enrolled in the study for the duration of the surgery and for 6 hours post operatively, during which pressures would be transduced and recorded form a central line and a peripherally placed intravenous catheter.
• All patients ages 18-99 presenting for spine surgery in the prone position and deemed to require a central line for monitoring are eligible for the study.
• Patients younger than 18 years old and older than 99
• Patients having contraindications for central line or peripheral line placements such as infection of the skin at the intended site of insertion and known vascular abnormalities of the central venous system (i.e., blood clots, vascular occlusions, etc.)
• Patients having poor peripheral venous access site availability
Stavros G. Memtsoudis, MD