How to estimate right atrial pressure with echocardiography ?
Posted Nov 03 2009 10:01pm
Estimation of right atrial pressure (Often referred to as central venous pressure (CVP) is a common hemodynamic excercise both at the bed side and in echocardiographic lab. A venous catheter inside the right atrium is probably the best way to measure it accurately .But, there are practical issues for putting and maintaining a CVP catheter. ( & We also know , what happened to the concept of routine swan catheter in critically ill patients !).
A rapid bed side echocardiography can give us a fairly accurate estimation of RA pressure . We don’t even need look into the heart , what you need is imaging the inferior vena cava , it’s size and it’s behavior with respiration . You don’t require a doppler probe either ! With these two parameters one can decode the mean RA pressure. This modality is rarely used in the ICUs , it can be a simple aid to fluid management .
Shrewd clinicians would argue , we have a natural catheter inside the right atrium, ie the internal jugular vein This gives us a unique opportunity to study the moment to moment RV, RA pressure . And . . . yes , we know it but we rarely respect the neck veins !