Bedside Ultrasound Improves The Accuracy of Jugular Venous Pressure Assessment

Abstract

Background Evaluation of jugular venous pressure (JVP) can provide a valuable estimate of intravascular volume status, however its sensitivity and accuracy are operator dependent and highly variable. Hypothesis Bedside ultrasound (US) of the internal jugular vein will improve the accuracy of JVP assessment. Methods Three internal medicine residents underwent a 30-minute practicum on ultrasound assessment of JVP. Over the following 13 months the residents evaluated 64 total patients immediately prior to invasive right heart catheterization (RHC). The residents measured patients’ neck circumference and then assessed JVP first by physical exam (PE-JVP) followed by ultrasound (US-JVP, Site Rite, Bard Inc.). The results were compared to central venous pressure (CVP) measured by RHC (CVP-RHC) using correlation coefficients and receiver operating curve analysis. Results Overall, US-JVP was more sensitive than PE-JVP in detecting an elevated CVP (≥10 cm H2O) (91% versus 75%); however, specificity was just 46% for both. There was modest agreement between PE-JVP (r = 0.38, p Conclusion Use of bedside US improves the accuracy of noninvasive assessment of CVP, particularly in patients with larger neck circumference. As with any learned skill considerable inter-operator variability exists related to training and frequency of use.