Hand Vein Assessment
We have found that the dorsum of the hand can provide fertile ground for estimating central venous pressure. When the internal or external veins are unavailable, try using the hand veins to estimate central venous pressure. When the hands are at the patient’s side, check for engorgement of the veins. If present, lift the hand high above the patient’s chest until the veins drain and flatten. Then, slowly lower the hands down to find the moment that the veins begin to fill. The distance between the top of the hand and the angle of Louis can be used to estimate central venous pressure (by adding to it the estimated distance between the angle of Louis and center of the right atrium). This technique may also be useful in the setting of severe tricuspid regurgitation, when the average central venous pressure can be difficult to estimate using the veins of the neck.
Patient 1:
This patient was admitted to the hospital for an exacerbation of cystic fibrosis. He was found to have elevated central venous pressure related to pulmonary hypertension.
Hand Vein Assessment
Patient 2:
This is a middle-aged man with high-output heart failure from cirrhosis.
JVP in forearm