Chest
Clinical Investigations in Critical CareDetection of Renal Blood Flow Abnormalities in Septic and Critically III Patients Using a Newly Designed Indwelling Thermodilution Renal Vein Catheter
Section snippets
Catheter Design
The catheter was designed with the following specifications (Critikon Corporation, Tampa, FL): 5-F, double lumen, radiopaque polyvinylchloride catheters, with 100 cm of usable length, containing a rapid response thermistor with standard Edwards connectors. The catheter is fashioned with a 180° bend 2 cm from the distal end, allowing the catheter tip to curl within the renal vein. A 45° bend 6 cm from the distal tip allows access to the renal vein (Fig 1).
Catheter Calibration
In vitro flow experiments were used to
In Vitro Catheter Calibration and Computation Determination
Thermodilution catheter measurements correlated strongly (r=0.997, p<0.001) when compared with the amounts collected volumetrically in the in vitro system (Appendix 1, Fig 2). The catheter measurements were shown to be accurate over the range of flows from 150 to 2,500 ml/min.
Catheter Insertion
Correct positioning of the renal vein catheter was confirmed by both fluoroscopic imaging and simultaneous renal vein, arterial and vena caval blood oxygen levels. Renal vein Po2 levels averaged 9.2 mm Hg higher than vena
Discussion
We have developed a renal vein catheter that measures RBF in septic and critically ill patients. The catheter can determine RBF by two techniques: CPAH levels (with extraction coefficient determination) and thermodilution-derived RBF. This study documents the feasibility of using indwelling renal vein catheters in critically ill patients in the intensive care unit.
Previous investigators have found variable reductions in renal PAH extraction in septic patients due to a variety of causes
PAH Clearance Method
An 8 mg/kg bolus of PAH was followed by a continuous infusion calculated to obtain a serum level of 1 to 2 mg/dl. After a 1-h equilibration period, two 30-min collections were obtained. Bladders were carefully drained by an indwelling Foley catheter and saline solution and air irrigations of the bladder were performed if urine output was less than 60 ml/h during the collection period. Renal vein, arterial and urine samples were obtained at the beginning and end of each collection period. PAH
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Manuscript received October 26; revision accepted January 31, 1990.
Presented in part at the annual meeting, American Federation for Clinical Research, San Diego, CA, May 1987, and the 16th Annual Educational and Scientific Symposium, Society of Critical Care Medicine, Anaheim, CA, May 1987. Published in abstract form in Clin Res 1987;34:884a, and Crit Care Med 1987;15:435.