Comparison of Clinical Measurement of Jugular Venous Pressure Versus Measured Central Venous Pressure

Demeria, Denny; MacDougall, Arlene; Spurek, Monika; Reid, John; Laframboise, Karen; Taylor-Gjevre, Regina M.; Gjevre, John

doi:10.1378/chest.126.4_meetingabstracts.747s

Cited by 17 publications

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there are many limitations to the current method that result in poor sensitivity and low overall diagnostic accuracy. [2][3][4][5][6][7][8] The first is the lack of certainty offered by visual inspection of the neck veins to determine if the jugular venous pulsation is present above the clavicle or not. The jugular venous pulsation may not be detected for multiple reasons including: 1) the jugular pulsations are obscured below the clavicle due to normal or low JVP, 2) The jugular pulsations reside above the mandible due to very elevated JVP, 3) Patient's body habitus or neck girth prevents visualization, or 4) clinician error.…”

Section: Introductionmentioning

confidence: 99%

Novel point-of-care ultrasound (POCUS) technique to modernize the JVP exam and rule out elevated right atrial pressures

Istrail

Stepanova

2021

Preprint

View full text Add to dashboard Cite

Accurate assessment of the jugular venous pressure (JVP) and right atrial pressure (RAP) has relied on the same bedside examination method since 1930. While this technique provides a rough estimate of right-sided pressures, it is limited by poor sensitivity and overall diagnostic inaccuracy. The internal jugular vein (IJV) is difficult to visualize in many patients and relies on an incorrect assumption that the right atrium lies 5 centimeters below the sternum. Point-of-care ultrasound (POCUS) offers an alternative method for more precisely estimating JVP and RAP. We propose a novel method of measuring the right atrial depth (RAD) using a sonographic measurement of the depth of the posterior left ventricular outflow tract as a surrogate landmark to the center of the right atrium when viewed in the parasternal long axis view. This is combined with determination if JVD was present at the supraclavicular point. Sensitivity, specificity, PPV, NPV of JVD at the supraclavicular point was 70%, 76%, 59%, 91% respectively. These values were confounded by the lack of standardization of zero reference landmarks (ZRLs) used during the right heart catheterizations. When the RAD estimate was adjusted to account for measurement error the sensitivity of JVD at supraclavicular point for elevated RAP improved to 90% with negative predictive value of 96%. This may offer a rapid and reliable method for ruling out elevated RAP and increase objectivity in our volume status assessment.

show abstract

Section: Introductionmentioning

confidence: 99%

Novel point-of-care ultrasound (POCUS) technique to modernize the JVP exam and rule out elevated right atrial pressures

Istrail

Stepanova

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…2 Pulmonary artery systolic pressure (SPAP) is easily derived by DE by adding to an estimated value of the right ventricular (RV) end-systolic pressure the right atrial (RA) pressure, obtained by calculating the inferior vena cavae (IVC) diameter along with the respiratory dynamics. 4,5 The RA plays multiple roles in the cardiac cycle: acting as a reservoir for the systemic venous return when the tricuspid valve is closed, as a passive conduit when the tricuspid opens and, lastly, acting as an active conduit when it contracts. In addition, estimating the IVC is not always easily obtained due to the anatomical difference of every patients, and, moreover, it scarcely correlates with invasive measurements.…”

mentioning

confidence: 99%

“…In addition, estimating the IVC is not always easily obtained due to the anatomical difference of every patients, and, moreover, it scarcely correlates with invasive measurements. 4,5 The RA plays multiple roles in the cardiac cycle: acting as a reservoir for the systemic venous return when the tricuspid valve is closed, as a passive conduit when the tricuspid opens and, lastly, acting as an active conduit when it contracts. 4 The reservoir phase of the RA is a dynamic rather than a static phase of cardiac cycle and RA deformation is dependent on pulmonary pressures exerted on the right ventricle (RV) and therefore backwards on the RA.…”

mentioning

confidence: 99%

Right Atrial Speckle Tracking Analysis as a Novel Noninvasive Method for Pulmonary Hemodynamics Assessment in Patients with Chronic Systolic Heart Failure

Padeletti¹,

Cameli²,

Lisi³

et al. 2011

Echocardiography

View full text Add to dashboard Cite

show abstract

“…However, the IJV is often obscured by the overlying neck tissues making clear visual identification difficult, particularly for the less experienced examiner [ 34 ]. Consequently, the accuracy of the visual inspection technique has been shown to be little better than about 50–60% [ 35 , 36 ]. It should also be noted that substantial variations can occur in observed CVP due to errors in transducer placement when taking invasive catheter measurements [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Central venous pressure estimation from ultrasound assessment of the jugular venous pulse

et al. 2020

View full text Add to dashboard Cite

Objectives Acquiring central venous pressure (CVP), an important clinical parameter, requires an invasive procedure, which poses risk to patients. The aim of the study was to develop a non-invasive methodology for determining mean-CVP from ultrasound assessment of the jugular venous pulse. Methods In thirty-four adult patients (age = 60 ± 12 years; 10 males), CVP was measured using a central venous catheter, with internal jugular vein (IJV) cross-sectional area (CSA) variation along the cardiac beat acquired using ultrasound. The resultant CVP and IJV-CSA signals were synchronized with electrocardiogram (ECG) signals acquired from the patients. Autocorrelation signals were derived from the IJV-CSA signals using algorithms in R (open-source statistical software). The correlation r-values for successive lag intervals were extracted and used to build a linear regression model in which mean-CVP was the response variable and the lagging autocorrelation r-values and mean IJV-CSA, were the predictor variables. The optimum model was identified using the minimum AIC value and validated using 10-fold cross-validation. Results While the CVP and IJV-CSA signals were poorly correlated (mean r = -0.018, SD = 0.357) due to the IJV-CSA signal lagging behind the CVP signal, their autocorrelation counterparts were highly positively correlated (mean r = 0.725, SD = 0.215). Using the lagging autocorrelation r-values as predictors, mean-CVP was predicted with reasonable accuracy (r 2 = 0.612), with a mean-absolute-error of 1.455 cmH 2 O, which rose to 2.436 cmH 2 O when cross-validation was performed. Conclusions Mean-CVP can be estimated non-invasively by using the lagged autocorrelation r-values of the IJV-CSA signal. This new methodology may have considerable potential as a clinical monitoring and diagnostic tool.

show abstract

Comparison of Clinical Measurement of Jugular Venous Pressure Versus Measured Central Venous Pressure

Cited by 17 publications

References 0 publications

Novel point-of-care ultrasound (POCUS) technique to modernize the JVP exam and rule out elevated right atrial pressures

Novel point-of-care ultrasound (POCUS) technique to modernize the JVP exam and rule out elevated right atrial pressures

Right Atrial Speckle Tracking Analysis as a Novel Noninvasive Method for Pulmonary Hemodynamics Assessment in Patients with Chronic Systolic Heart Failure

Central venous pressure estimation from ultrasound assessment of the jugular venous pulse

Contact Info

Product

Resources

About