Research On The Status Of Central Venous Pressure Measurement And The Influence Of The Cavity Selection On The Central Venous Pressure Measurement

Background:Central venous pressure (CVP) measurement is a basic and common method in hemodynamics monitoring, and the status of effective circulating blood volume and right heart function can be evaluated through the measurement of central venous pressure, which is the basis for the medical treatment, medicine and nursing. The measurement of central venous pressure is achieved by using the central venous catheter of percutaneous puncture. Initially central venous catheter was a single cavity catheter, in recent years, the multi-cavity central venous catheter is used widely, including double cavity, three cavity and four cavity catheter. The double cavity central venous catheter is used the most popular. According to literature review, there are many factors affect the central venous pressure.And revelant study show that the clinical status of CVP measuremen tis not optimistic, the measurement methods are different and the operation is not standard. What’s more,there is few study relating to the influence of different cavity on the CVP measurement. Therefore, know the current domestic status of central venous pressure measurement, and then know the cavity selection when using double cavity central venous catheter. Depend on that status study, design experiment study to explore the influence of cavity selection on the CVP measurement is of great significance.Objective: 〥evelope the quetionnaire of "Status of CVP measuremet";② To investigate whether there are differences in the central venous pressure between central venous chamber and peripheral venous chamber;③ To provide the basis for the clinical practice guidelines of central venous pressure measurement.Methods:This study consists of three phases.Phase 1-Development of the Status Study Questionnaire:According to literature review, many influence factors are found. Then the items were selected by experts consultation among 20 experts, And based on the expert consultation result and revelant knowledge of CVP measurement, develop the Status Study Questionnaire and establish the content validity index (CVI) and the test-retest reliability;Phase 2-Status study of CVP measurement:Totally 236 intensive care specialist nurse students of Chinese nursing association in 2014 were recruited. The survey instrument is the" Status Study Questionnaire" developed in Phase 1. Using frequency and percentage to conmplete the statistical description;Phase 3-Experimental research whether cavity selection influence the central venous pressure measurement. Through Convenient sampling, eventually 53 patients from the Intensive Care Unit of atop three hospital were recruited. According to self-control method, the result of central venous pressure was measuring from the central and peripheral chamber each time.Results:Phase 1-Through literature review and expert consultation,11 influence factors were confirmed. Based on these 11 influence factors and revelant knowledge about central venous pressure measurement, the Status Study Questionnaire was formulated.The content validity is 0.94, and the retest reliability of 0.97;Phase 2-There were 236 participants in this survey, the most commonly used central venous catheter was double cavity or multi-cavity reported by 173 participants (73.30%); The results of central venous pressure measuring from the central chamber were 131 participants (55.50%), measuring from the peripheral chamber were 8 participants(3.40%), and with no specific provision were 97 participants(41.10%);3. Phase 3-There were 53 patients who meet the standards during the study, which included 47 males and 6 females, whose average age was 19-92(70.64±16.64)years old. And the average t measuring resuls from central chamber was (8.75±4.22) mmHg, while measuring results from peripheral chamber was (10.25±4.09) mmHg, finally the t value between the different chamber was 6.429, P< 0.01, there was significant difference in statistically;④ There was correlation between the result of central venous pressure from central chamber and peripheral chamber, and the correlation coefficient was 0.970.The central venous pressure(central chamber)=0.999* central venous pressure (peripheral chamber)-1.483.Conclusion:①There is no uniform standard of central venous pressure measurement, and the influence factors was confirmed to be effective in literature, which have not been popularized in general practice. ② There is no uniform standard in the choice of central venous pressure chamber in double cavity central venous catheter, so the nurses chose the chamber to measure the central venous pressure according to individual habits.③ The influence factors of central venous pressure measurement were determined by the different chamber of double cavity central venous catheter, which was based on the strict limits of other factors.④ The regression model of different chamber for central venous pressure measurement was constructed with the regulation of chamber, which can reduce the error of central venous pressure measurement and ensure the accuracy;⑤ Central venous pressure measurement is important of severe patients, which need to carry out the wider range, more professional, more systematic study of the multi-center based on evidence, to build the clinical practice guideline of central venous pressure measurement and applied to clinical work.