Correlation Between Peripheral Venous Pressure and Central Venous Pressure in the Cardiac Intensive Care Unit

The treatment of numerous cardiac conditions requires assessment of intravascular volume
status, using central venous pressure (CVP) as the gold standard. Measurement of CVP requires
placement of an invasive venous catheter, with insertion of a venous catheter into a central
vein to obtain CVP. Catheter placement is invasive, costly and not without complications.
Ideally, there would exist a peripheral surrogate for CVP that would be 1) minimally invasive
to obtain, 2) low cost and 3) strongly correlate with CVP over a wide range of physiological
conditions.

The peripheral venous system is in continuity with the central venous system and, as such,
would be expected to have a pressure that correlates with central venous pressure. Numerous
previous studies suggest a correlation between peripheral venous pressure (PVP) and central
venous pressure. Prior studies have demonstrated a reasonable correlation between CVP and PVP
in patient populations including decompensated heart failure, cardiac and non-cardiac
surgery(1), liver transplant donors(2) and recipients(3), neurosurgical(4) and pediatric
patients.(5) In an earlier study published by the authors of this paper, the mean difference
between PVP and CVP in patients with acute heart failure syndromes was 0.4 mmHg with a
correlation coefficient of 0.947. One limitation of the earlier study was that it established
this correlation at only one point in time. In the study presented here, PVP and CVP will be
obtained and correlation will be assessed across multiple time points during a given
patient's hospitalization.

This is a prospective, single center cohort study to investigate the correlation between
peripheral venous pressure and central venous pressure.

Inclusion Criteria:

- We plan to enroll patients who meet the following criteria: Patients admitted to an
intensive care unit for invasive hemodynamic monitoring. All eligible patients will be
those who have already undergone pulmonary artery catheterization via the internal
jugular or subclavian veins and upper extremity peripheral IV placement per routine
standard of care prior to enrollment.

Exclusion Criteria:

- Patients will be excluded from this study for the following reasons: age less than 18
years of age, inability to obtain consent, femoral pulmonary artery catheter, or if
their attending physician refuses to allow enrollment.