Contributor: Steven Stroud
Bedside assessment of volume status is an age-old practice for clinicians. Spoiler alert: we are not very good at it. So, is there an alternate, accurate, less invasive way to assess volume status in decompensated heart failure patients other than measurement of central hemodynamics? Well, every hospitalized patient gets (at least) one peripheral intravenous (IV) line. What if we transduced the peripheral venous pressure (PVP) to estimate central venous pressure (CVP)? Sperry and colleagues demonstrated that PVP was highly correlated with CVP (r=0.947). OK, but does that help me estimate pulmonary catheter wedge pressure (PCWP)? PVP was mildly correlated (r=0.57) with PCWP, but patients with PVP >10mmHG did have a 100% positive predictive value of PCWP >20mmHg (n=13). Big news— worry less about keeping batteries in that little flashlight for the neck exam.
The study included a total of 30 patients with acute, decompensated HF (mean EF of 25%, 7 with HFpEF, 23 with HFrEF <50%). The size (i.e. gauge) and anatomic location of peripheral IVs did not influence the PVP tracing or accuracy in this study. It’s worth mentioning that the PVP and CVP measurements were taken at one point in time, so the validity of PVP used to trend volume status is not established.
In a heartbeat… Transducing peripheral IVs for PVP measurement may be a fairly accurate method to estimate initial volume status in acutely decompensated HF patients. It might be time to order more transducer kits.