Title: Peripheral Venous Pressure: An Alternative to Central Venous Pressure?
Authors: Dr Rajeev DS, Dr Sheela Verghese
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.154
Abstract
Background - Central Venous Pressure (CVP) monitoring is useful in the assessment of the right ventricular preload and also to guide fluid therapy. Neurosurgical procedures like craniotomies for brain tumours, aneurysms and operative procedures for spinal meningiomas are associated with excessive blood loss and hemodynamic fluctuations. Thus CVP monitoring plays an important role in these patients. However central venous catheterization is an invasive procedure and is associated with complications like arrhythmias, pneumothorax, vascular injury and cardiac tamponade. Peripheral venous pressure (PVP) monitoring can be used as a substitute for central venous pressure monitoring and thus technical difficulty and complications of the same can be avoided.
Material and Methods- We investigated 25 patients posted for neurosurgical procedures. Central venous catheter and peripheral venous catheter were connected to a pressure transducer and linked to a multichannel monitor, and both the readings were noted at 15-minute interval simultaneously. In this prospective observational study, we investigated whether CVP can be predicted from PVP and also whether PVP can be substituted for CVP.
Results- Peripheral venous pressure was consistently higher than central venous pressure, and both were positively correlated. There was a time-dependent increase in the correlation coefficient between CVP and PVP. Multiple linear regressions demonstrated statistically significant association between CVP and PVP (P value <0.001). Agreement between CVP and PVP was calculated using intra class correlation coefficient and Bland Altman plot. There was statistically significant agreement between CVP and PVP.
Conclusion- Peripheral venous pressure can be used to predict central venous pressure as an easier surrogate measurement for the assessment of right heart filling pressure and also for guidance of fluid therapy, in neurosurgical patients. We found that there was a correlation between CVP and PVP in these patients. CVP can be predicted from PVP with proper adjustment for age sex and BMI. Changes in CVP mirrored changes in PVP.
Key Words—Central venous pressure, Peripheral venous pressure, neurosurgical patients.
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