Erroneous measurement of haemodynamic parameters by PiCCO™ monitor in a critically ill patient with renal replacement therapy: a case report

Abstract

The PiCCO™ monitor (Pulsion Medical System, Melsungen, Hessen, Germany) has become an alternative method of haemodynamic invasive monitoring for the critically ill patient. The determination of the continuous cardiac output by arterial pulse contour analysis requires the periodic calibration of the monitor. This calibration is performed by the injection of a bolus of 15-20 ml cold saline through a central line catheter [1-3].

We present the case of a 54-year-old woman with breast cancer who underwent cord decompression surgery for bone metastasis. On the seventh postoperative day she developed multiorgan system failure (septic shock + respiratory insufficiency + acute renal failure + disseminated intra-vascular coagulopathy) due to nosocomial pneumonia. The patient was admitted to the intensive care unit and the PiCCO™ monitor was used for invasive haemodynamic monitoring. A Certofix™ Trio HF catheter (Braun, Munich, Bayern, Germany) was placed uneventfully in the right internal jugular vein to carry out continuous venous-venous haemodialysis (CVVH-D). The Certofix™ Trio HF is a triple-lumen catheter made of polyurethane with three lumens (first channel, distal = 16 G; second channel, middle = 12 G; and third channel, proximal = 12 G). The distal lumen was used for the calibrations of the PiCCO™ monitor due to the high-risk of insertion of another central line in a patient with severe coagulopathy. The analysis of the area under the thermo-dilution curve showed a hypodynamic state that was treated following the PiCCO™ monitor algorithm