Objective: To determine the correlation between central venous pressure (CVP) measured by conventional central venous access and ultrasonographic measurement of internal jugular vein (IJV) height and inferior vena cava (IVC) diameter. Methods: A prospective, cross-sectional, convenience sampling observational study. Results: 25 patients from the Emergency Department (ED) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were studied between 1st March and 30th April 2013. The median age was 63 years (95% CI 54-67). There was a significant correlation between IJV height and CVP using central venous access (r=0.64 p<0.001). Correlation between IVC diameter in end expiration and CVP was 0.74 (p<0.001). An IJV height measurement >8cm predicted a CVP >8cm H2O (sensitivity 71.4%, specificity of 83.3%). Conclusion: Measurement of IJV height and IVC diameter by ultrasonography correlates well with invasive CVP and is useful for the assessment of volume status in critically ill patients in the ED.
Central Venous Pressure

Percutaneous cannulatien has become an accepted technique for monitoring central venous pressure and pulmonary wedge pressure via a Swan Gans catheter. The technique is not without hazard. Complications include thrombophlebitis, infection and hydrothorax. These are case reports demonstrating the complications of hydrothorax and broken catehters from central venous catheterization.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Central Venous Pressure ; Hydrothorax* ; Pulmonary Wedge Pressure ; Thrombophlebitis

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.
Anesthesia ; Catheters ; Central Venous Pressure* ; Humans ; Subclavian Vein ; Venous Pressure

No abstract available.
Central Venous Pressure* ; Critical Illness* ; Humans

Background A simple measurement of central venous pressure (CVP)-mean by the digital monitor display has become increasingly popular. However, the agreement between CVP-mean and CVP-end (a standard method of CVP measurement by analyzing the waveform at end-expiration) is not well determined. This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude (ΔCVP= CVPmax - CVPmin) during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.Methods In total, 291 patients were included in the study. CVP-mean and CVP-end were obtained simultaneously from each patient. CVP measurement difference (|CVP-mean - CVP-end|) was defined as the difference between CVP-mean and CVP-end. The ΔCVP was calculated as the difference between the peak (CVPmax) and the nadir value (CVPmin) during the respiratory cycle, which was automatically recorded on the monitor screen. Subjects with |CVP-mean - CVP-end|≥ 2 mmHg were divided into the inconsistent group, while subjects with |CVP-mean - CVP-end| < 2 mmHg were divided into the consistent group.Results ΔCVP was significantly higher in the inconsistent group [7.17(2.77) vs.5.24(2.18), P<0.001] than that in the consistent group. There was a significantly positive relationship between ΔCVP and |CVP-mean - CVP-end| (r=0.283, P <0.0001). Bland-Altman plot showed the bias was -0.61 mmHg with a wide 95% limit of agreement (-3.34, 2.10) of CVP-end and CVP-mean. The area under the receiver operating characteristic curves (AUC) of ΔCVP for predicting |CVP-mean - CVP-end| ≥ 2 mmHg was 0.709. With a high diagnostic specificity, using ΔCVP<3 to detect |CVP-mean - CVP-end| lower than 2mmHg (consistent measurement) resulted in a sensitivity of 22.37% and a specificity of 93.06%. Using ΔCVP>8 to detect |CVP-mean - CVP-end| >8 mmHg (inconsistent measurement) resulted in a sensitivity of 31.94% and a specificity of 91.32%.Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios. ΔCVP during the respiratory period is related to the variation of the two CVP methods. A high ΔCVP indicates a poor agreement between these two methods, whereas a low ΔCVP indicates a good agreement between these two methods.
Humans ; Central Venous Pressure ; Respiration ; ROC Curve

A central venous catheter is inserted through the subclavian vein for the purpose of administration of fluids and drugs, and the monitoring of the central venous pressure. Central venous catheterization is associated with complications that may occur during the insertion of the catheter or owing to the aberrant location of its tip. A malpositioned catheter can result in faulty central venous pressure reading or lead to thrombosis of the vein. Many attempts have been made to correctly place a central venous catheter into the superior vena cava. We report a case where the cephalad direction of the flexible end of a J type guidewire was related to the guidewire advancing into the internal jugular vein.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Central Venous Pressure ; Jugular Veins* ; Subclavian Vein ; Thrombosis ; Veins ; Vena Cava, Superior

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the developement of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(7.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who were managed in the position of 30degrees and 50degrees head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sign and central venous pressure.
Central Venous Pressure ; Head* ; Humans ; Intracranial Pressure* ; Perfusion* ; Vital Signs*

Monitoring of the central venous pressure is a simple, relatively inexpensive method of assessing a patient's cardiac status, circulating blood volume, and vasomotor tone. The simplest way of checking the intrathoraeic location of the catheter tip is by observing oscillation of 2~4cmH2O in the manometer column, synchronous with respiratory cycle. Inaccurate measurements are often obtained by the misplacement of the central venous catheter tip, in addition to the other well-known complications. Radiographic identification of the catheter tip is essential to eliminate these problems. We experienced a case of arrhythmia which appeared upon misplacement of the central venous catheter tip, and confirmed its misplacement by radiographic study.
Arrhythmias, Cardiac ; Blood Volume ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Methods

OBJECTIVE: The central venous pressure(CVP) could affect the vertebral venous pressure, which in turn may influence blood loss during lumbar spinal surgery. The authors perform prospective clinical study to investigate the influence of the CVP on the amount of intra-operative blood loss and operating time. METHODS: Total 134 patients having various degenerative lumbar spinal pathology were treated by laminectomy and spinal fusion using posterior lumbar interbody fusion with cages and pedicle screws. The CVP was measured after prone positioning in all the patients. The correlation between the CVP and intra-operative blood loss and operating time were analyzed. RESULTS: The mean CVP after prone positioning was 10 cmH2O(5-18). The mean amount of intra-operative blood loss and operating time were 1884 cc and 213 minutes, respectively. The amount of blood loss and operating time significantly increased with the extent of spinal fusion. The CVP was significantly correlated with intra-operative blood loss and operating time(p<0.05). CONCLUSION: With increased CVP on prone position, there is a tendency of increasing amount of blood loss and operating time. The measurement of CVP is useful in determining the position providing a bloodless field during spinal fusion.
Central Venous Pressure* ; Humans ; Laminectomy ; Pathology ; Prone Position* ; Prospective Studies ; Spinal Fusion* ; Venous Pressure

The purpose of this study was to evaluate the effect of needle tip design and position, and irrigant flow rate on apical pressure (AP) during root canal irrigation. Five human mandibular premolars were instrumented up to #35 (0.06 taper) using nickel-titanium rotary instruments. Three different needles according to change of needle tip design (notched, side-vented, and flat) were positioned at the point of 1, 3, and 5 mm from the apical constriction (needle tip position). For each needle tip design and position, APs were measured with varying flow rates of 0.05, 0.1, 0.2, and 0.3 ml/s. When the other conditions were controlled, AP increased with decreasing needle tip position or increasing irrigant flow rate (p < 0.05). The AP of flat needle was the highest, followed by notched, side-vented needle for the same needle tip position and irrigant flow rate. The APs at needle tip position of 1 mm or with more than 0.1 ml/s flow rate were higher than central venous pressure (5.88 mmHg) for all conditions. Flat needle was not recommended for clinical use due to sharp increase of AP with changing needle tip position and irrigant flow rate. For safe and effective root canal irrigation, irrigant should be applied with the needle tip position of 3 mm and flow rate of less than 0.05 ml/s.
Bicuspid ; Central Venous Pressure ; Constriction ; Dental Pulp Cavity ; Humans ; Needles