Original Article

Measurement of Central Venous Pressure from a Peripheral Intravenous Catheter in the Lower Extremity

Authors: Paul Cox, BS, Joel O. Johnson, MD, PHD, Joseph D. Tobias, MD

Abstract

Objectives: The measurement of central venous pressure (CVP) is used to assess intravascular status. Although this is usually accomplished by placement of a central venous catheter (CVC), there are circumstances when placement of a CVC may be technically difficult or impossible. The current study investigates the feasibility of measuring CVP from a peripheral intravenous catheter.


Methods: CVP was simultaneously measured from a CVC and from a peripheral intravenous site. The continuity of the peripheral intravenous catheter with the central venous system was evaluated by noting the change in the pressure measured from the peripheral catheter during a sustained inspiratory effort and during occlusion of the extremity (arm or leg) above the catheter.


Results: The cohort for the study included 37 adult patients. In 8 of the 37 patients (22%), there was no increase in the peripheral venous pressure (PVP) in response to a Valsalva maneuver or occlusion of the extremity above the intravenous site. For the upper extremity intravenous sites without a PVP increase, the PVP-CVP difference was 11.2 ± 6.2 mm Hg versus 2.7 ± 2.2 mm Hg in the patients in whom the PVP increased with these maneuvers (P< 0.0001). For the lower extremity intravenous sites without a PVP increase, the PVP-CVP difference was 7.6 ± 4.0 mm Hg versus 2.6 ± 1.9 mm Hg in the patients in whom the PVP increased (P < 0.0001). No variation in the accuracy of the technique was noted, depending on the size of the intravenous cannula, its location (upper versus lower extremity), CVP value, or patient positioning (supine, prone, lateral).


Conclusions: Provided that the PVP increases to a sustained inspiratory breath and occlusion above the intravenous site, there is a clinically useful correlation between the PVP and the CVP.


Key Points


* For the technique to work, one must demonstrate continuity between the peripheral and central venous system by demonstrating an increase in the peripheral venous pressure in response to a sustained inspiratory breath (Valsalva maneuver) and with occlusion above the intravenous site.


* The correlation between the central venous pressure and the peripheral venous pressure was not affected by the size of the intravenous catheter, the location of the peripheral intravenous cannula (upper versus lower extremity), or the central venous pressure value.


* This technique may be used to estimate central venous pressure if situations arise such as patient inaccessibility during a surgical procedure, technical problems, or patient-related factors that preclude placement of a central venous catheter. The technique can also be used to immediately estimate central venous pressure while there is preparation for placement of a central venous catheter.

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