Usefulness of the External Jugular Vein Examination in Detecting Abnormal Central Venous Pressure in Critically Ill Patients

Vinayak, Ajeet; Levitt, Joseph E.; Gehlbach, Brian K.; Pohlman, Anne S.; Hall, Jesse B.; Kress, John P.

doi:10.1001/archinte.166.19.2132

Cited by 68 publications

(35 citation statements)

References 24 publications

(43 reference statements)

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“…Assessment of volume status, primarily from inspection of the internal jugular vein to estimate CVP, is difficult to perform by clinical examination alone, especially if CVP is very low. 4 Inspection of the external jugular vein is perhaps easier than inspecting the internal jugular vein and appears to accurately estimate CVP, 5 but it does not allow the degree of precision necessary for EGDT. Echocardiography can estimate CVP based on respirophasic variation or collapsibility index, but this technique requires expensive equipment and sonographic expertise.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Keller

Melamed

Malinchoc

et al. 2009

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Keller

Melamed

Malinchoc

et al. 2009

Journal of Hospital Medicine

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“…18 Recent evidence suggests that using the external jugular veins allows accurate estimation of the central venous pressure. 12 Nevertheless, the inconsistent ability to demonstrate accurate assessments of RAP has led to the suggestion that clinicians should decide only whether the venous pressure is increased or not and forsake attempts to determine actual RAP values. 10 In the present study, investigators categorized the JVP and RAP into 3 categories, and these H&P examination guided estimates were associated with measured RAP (Figure 1).…”

Section: Estimation Of Rap and Pcwp By The Handp Examinationmentioning

confidence: 99%

Value of Clinician Assessment of Hemodynamics in Advanced Heart Failure

Drazner

Hellkamp

Leier

et al. 2008

Circ: Heart Failure

227

131

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Background-We determined whether estimated hemodynamics from history and physical examination (H&P) reflect invasive measurements and predict outcomes in advanced heart failure. The role of the H&P in medical decision making has declined in favor of diagnostic tests, perhaps because of the lack of evidence for utility. Methods and Results-We compared H&P estimates of filling pressures and cardiac index with invasive measurements in 194 patients in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. H&P estimates were compared with 6-month outcomes in 388 patients enrolled in ESCAPE. Measured right atrial pressure was Ͻ8 mmHg in 82% of patients with right atrial pressure estimated from jugular veins as Ͻ8 mmHg, and was Ͼ12 mmHg in 70% of patients when estimated as Ͼ12 mmHg. From the H&P, only estimated right atrial pressure Ն12 mmHg (odds ratio, 4.6; PϽ0.001) and orthopnea Ն2 pillows (odds ratio, 3.6; PϽ0.05) were associated with pulmonary capillary wedge pressure Ն30 mmHg. Estimated cardiac index did not reliably reflect the measured cardiac index (Pϭ0.09), but "cold" versus "warm" profile was associated with lower median measured cardiac index (1.75 versus 2.0 L/(min⅐m

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“…Information obtained from the EJV examination at critically ill patients can be used to assess central venous pressure, which may provide useful data about intravascular volume status, presence of congestive heart failure, or other abnormal conditions (Vinayak et al, 2006). The EJV is also used in microsurgical procedures as a recipient vein for the free flaps (Cheng et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

A Case of Unilateral Fenestration and Duplication of the External Jugular Vein

Snoj

Cvetko

2013

Int. J. Morphol.

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SUMMARY:The external jugular vein is increasingly being utilized as the recipient vein in head and neck free tissue transfers, and for cannulation in order to conduct diagnostic procedures or intravenous therapies. The variations in the patterns of its course, and knowledge of them, are therefore important. We report on a unique and previously non-described unilateral fenestration and duplication of the external jugular vein found during the neck dissection of a 77-year-old female cadaver. Embryological evaluation and clinical implications of the anomaly are described. Clinicians and surgeons performing neck vascular or reconstructive surgery should be aware of this variation of the external jugular vein in the hope of preventing inadvertent injury.

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Usefulness of the External Jugular Vein Examination in Detecting Abnormal Central Venous Pressure in Critically Ill Patients

Abstract: The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.

Cited by 68 publications

References 24 publications

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Value of Clinician Assessment of Hemodynamics in Advanced Heart Failure

A Case of Unilateral Fenestration and Duplication of the External Jugular Vein

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