Non-Invasive Bedside Assessment of Central Venous Pressure: Scanning into the Future

Abstract

BackgroundNoninvasive evaluation of central venous pressure (CVP) can be achieved by assessing the Jugular Venous Pressure (JVP), Peripheral Venous Collapse (PVC), and ultrasound visualization of the inferior vena cava. The relative accuracy of these techniques compared to one another and their application by trainees of varying experience remains uncertain. We compare the application and utility of the JVP, PVC, and handheld Mini Echo amongst trainees of varying experience including a medical student, internal medicine resident, and cardiology fellow. We also introduce and validate a new physical exam technique to assess central venous pressures, the Anthem sign.MethodsPatients presenting for their regularly scheduled echocardiograms at the hospital echo department had clinical evaluations of their CVP using these non-invasive bedside techniques. The examiners were blinded to the echo results, each other's assessments, and patient history; their CVP estimates were compared to the gold standard level 3 echo-cardiographer's estimates at the completion of the study.Results325 patients combined were examined (mean age 65, s.d. 16 years). When compared to the gold standard of central venous pressure by a level 3 echocardiographer, the JVP was the most sensitive at 86%, improving with clinical experience (p<0.01). The classic PVC technique and Anthem sign had better specificity compared to the JVP. Mini Echo estimates were comparable to physical exam assessments.ConclusionsJVP evaluation is the most sensitive physical examination technique in CVP assessments. The PVC techniques along with the newly described Anthem sign may be of value for the early learner who still has not mastered the art of JVP assessment and in obese patients in whom JVP evaluation is problematic. Mini Echo estimates of CVPs are comparable to physical examination by trained clinicians and require less instruction. The use of Mini Echo in medical training should be further evaluated and encouraged.

Evaluation of right atrial volumes and functions by real‐time three‐dimensional echocardiography in patients after acute inferior myocardial infarction

“…All patients underwent a complete cardiac evaluation, including patient history, physical examination, and standard 12‐lead electrocardiogram ECG. The clinical evaluation of jugular venous pressure (JVP) was conducted using a noninvasive bedside technique . All patients underwent primary PCI within 30 minutes, as suggested by the current guidelines .…”

“…The clinical evaluation of jugular venous pressure (JVP) was conducted using a noninvasive bedside technique. 4 All patients underwent primary PCI within 30 minutes, as suggested by the current guidelines. 5 Thrombolysis in myocardial infarction (TIMI) flow was visually assessed after PCI by an experienced interventional cardiologist.…”

Assessment of central venous physiology of Fontan circulation using peripheral venous pressure

“…In fact, many researchers have tried to validate this assumption mostly in biventricular circulation and indeed consistently demonstrated significant associations between the 2 pressures. [20][21][22][23] However, correlation coefficients were not high enough, and differences between the 2 pressures were not always small enough to accurately estimate CVP using PVP. 22 In contrast, one previous study performed in patients with single ventricular circulation showed an excellent correlation between the 2 pressures.…”

Clinical assessment of central venous pressure: time for an update?

“…4 Medical students after only 10 h of training had a sensitivity of 100% for estimating CVP, whereas cardiology fellows using standard JVP assessment had a lower sensitivity of 86%. 5 Perhaps we need to accept the limitations of JVP assessment, and augment our physical examination with PoCUS. We suggest that PoCUS be integrated into medical curricula and subsequent RACP examinations in order to improve patient care.…”