JVP Estimation – Better with POCUS?

Written by Megan Hilbert

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Ultrasonographic estimation of JVP (jugular venous pressure) height in heart failure has been shown to enhance visual estimation of JVP on physical exam.

Why does this matter?
In heart failure patients, elevated CVP (central venous pressure) on admission and throughout hospitalization “was the strongest hemodynamic predictor of worsening renal failure”. With the use of ultrasound can we identify significantly elevated JVP earlier in their ED stay to assist our cardiology colleagues in planning interventions?

I feel my temperature pressure rising
Ultrasonographic estimation of JVP (uJVP) is completed with the linear probe in a transverse position parallel to the clavicle. Scanning the internal jugular vein cephalad until it tapers smaller than the carotid artery through the entire respiratory cycle. Vertical height of this taper is measured and added to the accepted distance of 5cm from the right atrium to the sternal angle.

This was a prospective observation study using convenience sampling with ultrasound images collected by POCUS trained cardiology fellows and a cardiology attending physician board certified in echocardiography. The uJVP was compared against physical exam estimation of JVP for accuracy as compared to the RAP (right atrial pressure) findings on right heart catheterization. This study found that uJVP had an AUC of 0.85 (95% CI 0.76-0.92) and odds ratio of 1.7 for every increase height of 1 cm – demonstrating that it is a feasible enhancement of physical examination estimation. The accuracy was, however, decreased in obese patients.

One limitation of this study is that the sonographers were cardiology trained and boarded in echo.  Current ED provider credentialing does not include estimation of JVP and widespread adoption of uJVP seems unlikely in this setting.

Source
Accuracy of Ultrasound Jugular Venous Pressure Height in Predicting Central Venous Congestion. Ann Intern Med. 2021 Dec 28. doi: 10.7326/M21-2781. Online ahead of print.

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