Comparison of Peripheral and Central Venous Pressures in Critically Ill Patients

Abstract

We conducted a prospective study to determine the relationship between central (CVP) and peripheral (PVP) venous pressures in critically ill patients. CVP and PVP were measured on five different occasions in 20 critically ill patients in the intensive care unit. Results showed that the mean difference between PVP and CVP was 4.4 mmHg (95% CI= 3.7 to 5.0). However, PVP might be 1.9 mmHg below (95% CI=0.7 to 3.1) or 10.6 mmHg above (95% CI=9.4 to 11.8) the CVP. The mean difference between changes in PVP and corresponding changes in CVP was 0.3 mmHg (95%CI=-0.1 to 0.7). The actual change in PVP could be 3.0 mmHg below (95% CI=2.3 to 3.7) or 3.6 mmHg above (95% CI=2.9 to 4.3) the change in CVP. Overall, the direction of change in PVP (rise or drop) predicted a same direction of change in CVP with an accuracy of 78%. Changes in PVP ≥2 mmHg predicted a change in same direction of CVP with an accuracy of 90%. The direction of changes in CVP ≥2 mmHg were predicted by the direction of change in PVP with an accuracy of 91%. We conclude that PVP measurement does not give an accurate estimate of the absolute value of CVP in individual patients. However, as changes in PVP parallel, in direction, changes in CVP, serial measurements of PVP may have a value in determining volume status and guiding fluid therapy in critically ill patients.

Effect of Body Temperature on Peripheral Venous Pressure Measurements and Its Agreement with Central Venous Pressure in Neurosurgical Patients

“…2 They observed a bias of 4.4 mm Hg (95% CI 3.7-5.0). They noticed extreme variation in PVP measurements, as high as 10.6 mm Hg above simultaneous CVP measurement.…”

“…Previous studies have shown evidence that CVP can be estimated by peripheral venous pressure (PVP) measurements, introducing PVP as a hemodynamic monitoring parameter in different clinical settings such as the operating room and intensive care units. 1,2 It is well known that under general anesthesia, an inevitable initial rapid decrease in body temperature occurs, followed by a linear decrease for 3-4 hours. 3,4 The classic physiologic response to hypothermia is peripheral vasoconstriction.…”

Effect of catheter site on the agreement of peripheral and central venous pressure measurements in neurosurgical patients

“…With improvement of central venous catheterization techniques in the mid-20th century, Pedersen [5] observed that CVP and PVP are related. However, the use of PVP over CVP has been evaluated only in recent years [1,6].…”

“…In a study performed by Charalambous et al [6], PVP and CVP were compared in 20 critically ill patients. They observed a bias of 4.4 (95% CI, 3.7-5.0).…”

Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation

“…Nearly thirty years later another trial correlated external jugular venous pressures with CVP in anesthetized surgical patients [6]. Several recent studies have demonstrated a strong correlation between PVP and CVP in different patient populations [7][8][9][10][11][12][13]. Patients with liver failure undergoing surgical procedures have not been evaluated for PVP/CVP correlation.…”