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Evidence Base: Neck Veins
Measurement of Jugular Venous Pressure
In this study, clinical assessment of the central venous pressure (CVP) of 50 patients in the intensive care unit was compared to the "gold standard" of simultaneous pressure measurements via an indwelling central venous catheter. The assessment was done by medical students, medicine residents and attending physicians. The correlation coefficient between the two methods of assessment was highest for the medical students (0.74), intermediate for residents and lowest for attendings (0.65). The student data is reported in the table below.
In summary, if a CVP is assesses as low, the likelihood of it being low is increased threefold. If a CVP is assessed clinically as high, the likelihood ratio is 4 and the likelihood of the CVP being low is 0.2
| Is the CVP Low? |
| Clinical Assessment |
Low, CVP<5 cm |
Normal or High, CVP >5 cm |
Likelihood Ratio that CVP is Low
(95% CI)
|
| CVP low |
3* |
5* |
3.4 (1.0-11.2) |
| CVP normal |
4* |
22* |
1.0 (0.5-2.1) |
| CVP high |
0* |
13* |
0 (0-1.5) |
| |
* Number of patients |
| Is the CVP High? |
| Clinical Assessment |
High, CVP >10 cm |
Normal or Low, CVP <5 cm> |
Likelihood Ratio that CVP is High
(95% CI)
|
| CVP high |
10* |
3* |
4.1 (1.3-13.1) |
| CVP normal |
10* |
16* |
0.8 (0.5-1.3) |
| CVP low |
1* |
7* |
0.2 (0.02-1.3) |
| |
* Number of patients |
Adapted from Cook, et al
|
