School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
J Vasc Access. 2024 Sep;25(5):1443-1449. doi: 10.1177/11297298231163352. Epub 2023 Mar 27.
Arterial lines and central venous catheter (CVC) allow to monitor patients' acid-base status and gas exchange. Their placement and maintenance may however be burdened by severe complications. Midline Catheters (MC) are peripheral venous accesses that are less invasive and easier to insert compared to CVC and arterial lines.
A prospective observational study was performed including stabilized critical patients with clinical indication to midline positioning before intensive care unit (ICU) discharge. The primary aim was to assess if venous sampling from MCs can be a reliable alternative to CVC for pH and CO monitoring. The secondary aim was to evaluate the correlation between samplings from MC, CVC and arterial line with regards to pH, carbon dioxide tension (pCO), lactates and electrolytes. Three samples from CVC, arterial line and MC were collected simultaneously. Agreement and correlation of the studied parameters between different sampling sites were explored.
40 patients were included in the analysis. A good agreement for pH and pCO was recorded between MC and CVC: mean differences were 0.001 (95% CI -0.006 to 0.007) and 0.7 (-0.1 to 1.5), percentage error 0.4% and 11.2%, respectively. Correlation between MC and both central venous and arterial samples for pH, pCO, lactates and electrolytes was found to be moderate-to-strong (Pearson's coefficient range 0.59-0.99, < 0.001 for all these parameters).
In stabilized critical patients, midline catheters represent a reliable alternative to CVC and arterial lines to monitor acid-base disturbances, CO levels and electrolytes. The present findings add to the known advantages of MC, which might be considered a first-line vascular access for non-critical or stabilized patients who do not require infusion of vesicant or irritant drugs.
动脉置管和中心静脉导管（CVC）可用于监测患者的酸碱状态和气体交换。然而，其置管和维护可能会带来严重的并发症。中线导管（MC）是一种外周静脉通路，与 CVC 和动脉置管相比，其创伤性更小，更容易插入。
进行了一项前瞻性观察性研究，纳入了稳定的危重症患者，这些患者在转入重症监护病房（ICU）前有中线置管的临床指征。主要目的是评估从 MC 进行静脉采样是否可以替代 CVC 用于 pH 和 CO 监测。次要目的是评估 MC、CVC 和动脉置管的采样之间在 pH、二氧化碳分压（pCO）、乳酸和电解质方面的相关性。同时从 CVC、动脉置管和 MC 采集 3 个样本。探讨了不同采样部位之间研究参数的一致性和相关性。
共纳入 40 例患者进行分析。MC 和 CVC 之间 pH 和 pCO 的一致性较好：平均差值分别为 0.001（95%CI-0.006 至 0.007）和 0.7（-0.1 至 1.5），百分比误差分别为 0.4%和 11.2%。MC 与中心静脉和动脉样本之间 pH、pCO、乳酸和电解质的相关性为中度至高度（Pearson 系数范围 0.59-0.99，所有这些参数均<0.001）。
在稳定的危重症患者中，中线导管是替代 CVC 和动脉置管监测酸碱紊乱、CO 水平和电解质的可靠选择。本研究结果进一步证实了 MC 的优势，对于不需要输注刺激性或腐蚀性药物的非危重症或稳定患者，MC 可以作为首选血管通路。
