FREQUENT measurement of central venous pressure is important in the maintenance of an effective blood volume in seriously ill patients.1 The difficulty in placing the tip of a catheter in the intra-thoracic vena cava and the fears of subsequent complications2-4 have discouraged the use of this measurement. The procedure described here provides a facile, accurate, and safe measurement of the central venous pressure.
A polyvinyl-chloride catheter with x-ray markings is placed into the superior vena cava in the following manner. With the patient in a supine, mild scultetus position and the face turned to one side, the external jugular vein becomes prominent when Valsalva's maneuver is performed. Using a local anesthetic, the low point of prominence of the vein is then isolated via a cutdown and a catheter, which is ultimately passed into the superior vena cava, is introduced into the vessel. Occasionally difficulty occurs in passing