Jugular Venous Pressure Measurement is Accurate when Performed by Attending Physicians on Internal Medicine Wards

Introduction Jugular venous pressure (JVP) is a widely used estimate of central venous pressure (CVP). It is unclear how accurate JVP measurement is by physicians in different stages of clinical practice. We investigated the accuracy of JVP measurement across different levels of medical training by comparing JVP measurements to the peripheral venous pressure (PVP) measurement, which has been shown to have a high degree of correlation to CVP measurements. Hypothesis JVP will be better correlated with CVP when measured by physicians of higher level of clinical training. Methods A prospective, cross-sectional study in which 82 participants (13 third or fourth-year medical students, 26 interns, 21 residents, and 22 attending internal medicine physicians) measured JVP in patients admitted for acute decompensated heart failure (ADHF) to the general medicine ward. JVP measurements were compared to the PVP measured from a peripheral intravenous catheter by standard technique. Results Forty-five patients were enrolled with a mean age of 69±14 years, mean body mass index (BMI) of 31±9 kg/m2, mean ejection fraction (EF) of 47±20%, and mean B-type natriuretic peptide (BNP) of 1242±1161 pg/ml. Mean JVP was 8.6 (4-18) cmH2O for medical students, 8.7 (4-16) cmH2O for interns, 9.1 (5-20) cmH2O for residents, and 9.2 (4-15) cmH2O for attending physicians. Mean PVP was 8.7 (1-20) mmHg. The JVP and CVP were found to have a moderate correlation (r=0.42, p=0.005) for attending physicians and a low correlation for medical students or residents. High-degree correlation among attending physicians was noted in patients with EF < 50% (r=0.60, p=0.009), BMI < 30 (r=0.55, p=0.008) and BNP > 1000 (r=0.56, p=0.01). Conclusions JVP is a reliable estimation of volume status in those admitted with ADHF when examined by an attending-level internal medicine physician, specifically in patients with a low BMI, low EF, and a high BNP.