Comparison of external jugular and central venous pressures in patients undergoing repair of proximal femoral fractures

Invasive cardiovascular monitoring during anaesthesia for patients with hip fractures is rare, which has attracted concern [1]. This may be partly because central venous pressure (CVP) monitoring has serious complications. However, CVP monitoring may reduce the incidence of perioperative hypotension and the time to discharge [2]. External jugular venous pressure (JVP) agrees with CVP in mechanically ventilated patients [3] and is simple and free from major complication. After LREC approval and informed consent, we compared external JVP with CVP in spontaneously breathing, anaesthetised patients having repair of fractured neck of femur. Patients were given a standard general anaesthetic, breathing spontaneously via a laryngeal mask airway. A single lumen 18-G catheter was placed to monitor CVP and a 32-mm 20-G cannula was placed in the external jugular vein. Paired measurements of mean CVP and mean external JVP were made at 10-min intervals by a blinded observer in random order and at end-expiration. Mean venous pressure was used to guide fluid challenges (Haemaccel 3 ml/kg). Patients’ position was determined by surgical procedure and surgical preference. Thirty-five patients were recruited but data were unavailable from four. Of the remaining 31, 22 were supine (157 measurements) and nine lateral (72 measurements). External JVP agrees closely with CVP in supine patients and is clinically useful, but the lateral position produces less agreement.