SonoSite ultrasound probe for measuring JVP

• Research type

  Research Study

• Full title

  Use of the SonoSite Probe for Measuring Jugular Venous Pressure

• IRAS ID

  254072

• Contact name

  Norman Briffa

• Contact email

  norman.briffa@sth.nhs.uk

• Sponsor organisation

  Sheffield Teaching Hospitals NHS Foundation Trust

• Clinicaltrials.gov Identifier

  NCT03815188

• Duration of Study in the UK

  0 years, 7 months, 31 days

• Research summary

  "Research Summary"
  This study will investigate which non-invasive method of measuring jugular venous pressure (JVP) is most accurate: physical JVP examination or ultrasound. JVP is an estimate of right heart pressure. In current practice, physical JVP examination is used to assess patients with suspected or known heart disease. Recent research indicates the use of an ultrasound probe may more accurately and reliably measure JVP. Finding out which method is best will enable doctors to assess JVP using the most appropriate investigation. This will allow doctors to make a more informed decision as to what further tests and treatments are required. An ultrasound probe will be used to record JVP measurements. This device is routinely used in hospitals and is commercially available for the purpose of measuring JVP. Patients undergoing heart surgery will be eligible for this study. Identifying the jugular venous pulse during the physical examination is more easily done in these patients, making this subset of patients most appropriate. Patients must also have a central line inserted as part of their surgery. The central line will measure central venous pressure and is the gold standard method for measuring right heart pressure. This will allow both the physical JVP measurement and the ultrasound measurement to be compared with the gold standard, identifying which method is most accurate. The site for this study is Sheffield Teaching Hospital NHS Foundation Trust. The trial will last 8 months. During the patient’s pre-operative assessment, a physical examination of JVP and ultrasound recording of JVP will be taken. The central line will be switched on to measure central venous pressure. The anaesthetist will complete the pre-operative assessment before the patient enters theatre. No additional visits will be required by the patient. Both the additional investigations are non-invasive and therefore make this a very low risk trial.

  "Summary of results"
  Doctors often need to check a patient's fluid levels and heart pressure-specifically, a metric called Central Venous Pressure (CVP). This is usually tracked by threading a invasive tube (a central line catheter) directly into a major vein near the heart.
  The traditional, non-invasive alternative is looking at the pulsing jugular vein in a patient's neck, but doing this by eye is notoriously inaccurate and difficult.
  This study, conducted at the Northern General Hospital in Sheffield, UK, tested whether a quick, painless scan using a portable ultrasound to look at the jugular vein (U-JVP) could accurately predict that internal heart pressure without needing an invasive line.
  What Did They Find?
  The researchers tested this on 114 patients recovering from heart surgery. They checked the ultrasound results both while patients were on a breathing machine (ventilated) and after they were breathing on their own.
  *
  It is highly accurate: The ultrasound measurements matched up incredibly well with the real, invasive pressure readings.
  *
  Breathing on your own yields the best results: The technique was incredibly precise in patients breathing naturally, only missing the exact pressure marker by a tiny fraction of a unit (0.11 mmHg). When patients were on a ventilator, the ultrasound still worked well but tended to very slightly overestimate the pressure by about 0.91 mmHg.
  *
  It catches highs and lows: The ultrasound technique proved to be highly reliable at flagging when a patient's fluid pressure was dangerously low or high.
  Why Does This Matter?
  The study concludes that using portable ultrasound on the neck is a highly accurate, safe, and completely non-invasive way to measure a patient's fluid status. Because it is simple and reliable, the researchers note it could easily be taught to medical students and healthcare workers. This could eventually change how doctors monitor fluid build-up in patients with heart failure-giving them a quick way to check heart pressures right at the bedside without ever having to poke a patient with a needle.

• REC name

  Wales REC 7

• REC reference

  19/WA/0039

• Date of REC Opinion

  6 Feb 2019

• REC opinion

  Favourable Opinion