Measurement of jugular venous pressure

To the Editor: In their recent letter, Colquhoun and Jenkins1 correctly note that the external jugular venous pressure is as reliable as the internal jugular venous pressure in estimating right atrial pressure. Furthermore, the external jugular vein is more readily visible and accessible for cannulation should accurate measurement be required.

While routine clinical observation is important, direct invasive measurement of right atrial pressure may be required in patients who are critically ill or experiencing rapid fluid shifts, as when undergoing major surgery. Potential serious complications of central venous cannulation are a significant barrier to direct measurement, but it has been suggested that cannulation of a central vein may not be required to assess right ventricular filling pressures.2 Indeed, the early observations of direct measures of venous pressure by Berger3 and others in the 1930s were performed in peripheral veins.

A more recent study by Amar et al2 showed a reliable correlation between peripheral venous pressure (PVP) and central venous pressure (CVP) in 150 patients without cardiac disease undergoing major non-cardiac surgery. PVP, measured in either the hand or forearm, was found to be 2–3 mmHg higher, on average, than CVP, with similar changes when fluid boluses were administered. Further studies have shown similar utility of PVP measurement in cardiac surgery,4 neurosurgery and paediatrics.5

The insertion of central venous catheters for pressure monitoring alone may not be warranted if connecting a pressure transducer to a simple cannula in a peripheral vein can attain the same information. Using peripheral venous pressure measurement, the risks of arterial puncture, pneumothorax and central venous catheter-related bloodstream infections can easily be avoided.