Central venous pressure
In physiology, the central venous pressure is "blood pressure in the central large veins of the body. It is distinguished from peripheral venous pressure which occurs in an extremity." Various disease states such as heart failure raise the central venous pressure. It may be approximated in physical examination, especially by cardiologists, and its continuous automated measurement is common in critical care.
Detection of elevated central venous pressure
Normal the examiner inspects the internal jugular vein while the patient sits reclined at an angle of 30° to 45°.. The jugular venous pulse (JVP) is distinguished from the carotid pulse by the jugular vein showing a biphasic pulsation from 'a wave' and 'a v wave'. The jugular pulse is considered abnormal if its meniscus is 4 or more centimeters above the sternal angle of Louis.
The JVP is considered abnormal when the meniscus of the pulse is 4 cm above the sternal angle of Louis when the patient is reclining at 45°. When examining the patient sitting upright, the jugular pulse is considered abnormal if it is visualized above the clavicle. When the pulsation is elevated the patient has jugular venous distention (JVD).
central venous pressure
left ventricular end diastolic pressure
|Jugular venous distention||48%||88%||55% to 65%||74% to 80%|
|Abdominojugular test||24% to 72%||96% to 93|
The physical examination of jugular venous distention is more specific than sensitive in detecting an elevated central venous pressure according to a systematic review by the Rational Clinical Examination (RCE).The accuracy of visualizing the meniscus of the jugular pulse at 4 or more centimers above the sternal angle of Louis in the reclining patient according to one study in included in the systematic review by the RCE:
If inspecting the patient sitting erect, visualizing the jugular pulse above the clavicle is:
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