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

Abstract

Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical settings. The effect of body temperature on PVP and its agreement with CVP in patients under general anesthesia are investigated in this study. Fifteen American Society of Anesthesiologists I-II patients undergoing elective craniotomy were included in the study. CVP, PVP, and core (Tc) and peripheral (Tp) temperatures were monitored throughout the study. A total of 950 simultaneous measurements of CVP, PVP, Tc, and Tp from 15 subjects were recorded at 5-minute intervals. The measurements were divided into low- and high-Tc and -Tp groups by medians as cutoff points. Bland-Altman assessment for agreement was used for CVP and PVP in all groups. PVP measurements were within range of +/-2 mm Hg of CVP values in 94% of the measurements. Considering all measurements, mean bias was 0.064 mm Hg (95% confidence interval -0.018-0.146). Corrected bias for repeated measurements was 0.173 +/- 3.567 mm Hg (mean +/- SD(corrected)). All of the measurements were within mean +/- 2 SD of bias, which means that PVP and CVP are interchangeable in our setting. As all the measurements were within 1 SD of bias when Tc was > or = 35.8 degrees C, even a better agreement of PVP and CVP was evident. The effect of peripheral hypothermia was not as prominent as core hypothermia. PVP measurement may be a noninvasive alternative for estimating CVP. Body temperature affects the agreement of CVP and PVP, which deteriorates at lower temperatures.

Peripheral Venous Pressure as a Predictor of Central Venous Pressure during Neurosurgical Procedures

“…Recently, however, numerous studies have reported a strong correlation between CVP and PVP in various surgeries. [3,10,12,13,15,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] As in other studies, we found a consistently higher value for PVP than for CVP. The mean difference of approximately 4mm Hg likely represents peripheral venous resistance upstream from the vena cava.…”

“…[11] Previously, some clinicians have introduced PVP, a simple and less invasive hemodynamic monitoring variable, as an alternative to CVP and found various correlations between them. [16,[18][19][20][21][22][23][24] PVP instead of CVP has not been widely advocated in the past because peripheral veins have valves that may interrupt the continuous column of blood and are thin walled, and may be more easily subjected to compression and occlusion. In addition, external compression by the operator or blood pressure cuff and overstretching in the catheterized arm can occlude the peripheral vein and increase PVP.…”

Peripheral venous pressure predicts central venous pressure poorly in pediatric patients

“…Correlation between PVP and CVP has already been investigated in studies of adult patients. [2][3][4][5][6][7][8] In most of these studies, subtracting a reliably constant offset, the difference by which the PVP exceeded the CVP, provided a clinically useful estimate of CVP. The relationship of PVP to CVP has been reported in a single study of pediatric patients, age three to nine, and demonstrated good agreement between CVP and PVP.…”

Non-invasive central venous pressure measurement by compression ultrasound—A step into real life

“…Several studies employing invasive and non invasive techniques showed a good correlation between peripheral venous pressure and CVP under a variety of study conditions in the operating room and the intensive care unit. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Basis for these studies is the fact, that in supine position pressure values within the cephalic, basilic and brachial veins are nearly identical to those of the superior vena cava. 4,5,19 Measurements of the inferior vena cava (IVC) diameter using ultrasound is frequently used to assess volume status of critically ill patients 20,21 , primarily distinguishing hypo-from iso-and hypervolemic conditions.…”