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Prehospital Invasive Arterial Pressure: Use of a Minimized Flush System

Published online by Cambridge University Press:  31 August 2018

Jonas Karlsson ,
Joacim Linde ,
Christer Svensen Open the ORCID record for Christer Svensen [Opens in a new window]  and
Mikael Gellerfors
Jonas Karlsson*
Affiliation:
Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
Joacim Linde
Affiliation:
Department of Anaesthesia and Intensive Care, Södra Älvsborg Hospital, Borås, Sweden
Christer Svensen
Affiliation:
Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden Karolinska Institutet, Department of Clinical Science and Education, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
Mikael Gellerfors
Affiliation:
Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden Karolinska Institutet, Department of Clinical Science and Education, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden Swedish Air Ambulance (SLA), Sweden
*
Correspondence: Jonas Karlsson, MD Department of Anaesthesia Södersjukhuset Stockholm, Sweden E-mail: jonas.o.karlsson@sll.se
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Abstract

Introduction

Invasive blood pressure (IBP) monitoring could be of benefit for certain prehospital patient groups such as trauma and cardiac arrest patients. However, there are disadvantages with using conventional IBP devices. These include time to prepare the transducer kit and flush system as well as the addition of long tubing connected to the patient. It has been suggested to simplify the IBP equipment by replacing the continuous flush system with a syringe and a short stopcock.

Hypothesis

In this study, blood pressures measured by a standard IBP (sIBP) transducer kit with continuous flush was compared to a transducer kit connected to a simplified and minimized flush system IBP (mIBP) using only a syringe.

Methods

A mechanical, experimental model was used to create arterial pressure pulsations. Measurements were made simultaneously using a sIBP and mIBP device, respectively. This was repeated four times using different mean arterial pressure (MAP): 40, 70, 110, and 140mm Hg. For each series, 16 measurements were taken during 20 minutes. Data were analyzed using Bland-Altman plots. Measurement error greater than five percent was regarded as clinically significant.

Results

Mean bias and standard deviation (SD) for systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP was -3.05 (SD = 2.07), 0.2 (SD = 0.48), and -0.3 (SD = 0.55) mmHg, respectively. Bland-Altman plots revealed that the bias and SD for systolic pressures was mainly due to an increased under-estimation of pressures in lower ranges. All MAP and 98.4% of diastolic pressure measurements had an error of less than five percent. Systolic pressures in the MAP 40 series all had an error of greater than five percent. All other systolic pressures had an error of less than five percent.

Conclusion

Thus, IBP with the mIBP flush system provides accurate measurement of MAP and DBP in a wide range of physiological pressures. For SBP, there was a tendency to under-estimate pressures, with larger error in lower pressures. Implementation of a simplified flush system could allow further development and potentially simplify the use of IBP for prehospital critical care teams.

KarlssonJ, LindeJ, SvensenC, GellerforsM. Prehospital Invasive Arterial Pressure: Use of a Minimized Flush System. Prehosp Disaster Med. 2018;33(5):490–494.

Keywords

arterial lineflushinvasive blood pressureprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 5 , October 2018 , pp. 490 - 494
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest/funding: The authors declare that they have no conflicting interests. The DTXplus pressure transducer kits were supplied free of charge from Argon Medical (Argon Medical Devices; Texas USA). No other funding was obtained.

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