Challenges associated with central venous catheter placement and central venous oxygen saturation monitoring.

Patients with septic shock and respiratory failure often require hemodynamic monitoring in order to guide bedside management. This is particularly true of patients with dialysis-dependent chronic kidney disease, who may be less tolerant of large volume resuscitation than individuals with normal renal function. With the declining use of pulmonary artery catheters and the introduction of early goaldirected therapy as a means for resuscitating patients with septic shock,1 central venous catheters (CVCs) are increasingly being used for this purpose. These catheters allow continuous monitoring of central venous pressure to guide fluid administration, as well as point measurement or continuous monitoring of central venous oxygen saturation (ScvO2), a surrogate measure of mixed venous oxygen saturation (SvO2) that provides information about the balance between oxygen delivery and consumption at the tissue level. In order to use the central venous pressure and ScvO2 to guide sepsis resuscitation or other aspects of patient management, the clinician must verify that the line is in the appropriate position and ensure there are no sources of error in the generated data. We present a case of a patient with chronic kidney disease who presented with sepsis and respiratory failure, which demonstrates some of the challenges that can arise in these regards and how to approach these situations.