|Year : 2015 | Volume
| Issue : 2 | Page : 77-80
Zaria-made jugulometre: Assessing its usefulness in bedside medicine
Shidali Y Vincent1, George G Nathaniel1, Yakubu D Peter1, Danbauchi S Solomon2
1 Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
2 Department of Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria
|Date of Web Publication||30-Jul-2015|
Shidali Y Vincent
Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika-Zaria
Source of Support: None, Conflict of Interest: None
Background: Despite the availability of more sophisticated and invasive procedures for central venous pressure measurement, the role of estimating the height (in cm of water) of the internal jugular vein at bedside cannot be overemphasized. A handy instrument for this purpose was compared with the age-long procedure of combining two rulers.
Objective: To compare the conventional means of jugular venous pressure (JVP) estimation with the use of a new instrument (Jugulometre).
Materials and Methods: Forty-one (41) patients with elevated JVP in heart failure were recruited consecutively from two centers in a prospective study. JVP was estimated by conventional method. This was repeated using the jugulometre with and without light source separately. The time taken and height of JVP were noted. Data analysis was done using SPSS statistical software (version 16).
Results: A total of 41 patients consisting of 21 (51.2%) males and 20 (48.8%) females with a mean age of 39.41 13.79 years were examined. Analysis was done comparing conventional method and instrument without light (pair 1), conventional method and instrument with light (pair 2), and instrument without light and instrument with light (pair 3). There was a significant positive correlation (r = 0.830,0.830, and 0.954, respectively) in the height of JVP (P < 0.000 each). Also the difference seen in the values of JVP height were not statistically significant (P > 0.174, 0.179 and 1.000). Time difference (in seconds) for measuring the JVP were found to be statistically significant (P < 0.004, 0.000 and 0.011) and shorter with the jugulometre.
Conclusion: The Zaria-made jugulometre is faster, less cumbersome and has comparable accuracy to the conventional way of JVP estimation by the bedside. It is therefore recommended for routine patient examination.
Keywords: Jugular venous pressure, time, zaria-made Jugulometre
|How to cite this article:|
Vincent SY, Nathaniel GG, Peter YD, Solomon DS. Zaria-made jugulometre: Assessing its usefulness in bedside medicine. Nig J Cardiol 2015;12:77-80
| Introduction|| |
The history of venous blood pressure is as long as the arterial counterpart particularly the jugular venous pressure (JVP) which is an indirect assessment of the pressure in the right atrium.  Many writers and clinicians have studied and emphasized the role of raised jugular venous pressure in the pathophysiology of heart disease centuries back. ,,
Several methods were adopted to measure venous pressure directly and indirectly. ,,,, To properly estimate the rise in the JVP height, Borst and Molhuysen  described a simple right-angled measure which can be used at the bedside.
After many decades, Ogunlade et al., in 2008 presented a similar instrument to the society of cardiologists in Nigeria. It was made up of two rulers fixed at one end in a fasion to allow one slide over the other.
This conventional method which practically involves the use of two (2) separate rulers has been the practice in clinical bedside medicine. However, there has been a systematic neglect of routine performance of this procedure at the bedside.  Despite this neglect, the role of JVP estimation in the diagnosis of heart failure, monitoring of cardiac hemodynamics and filling pressures in cardiovascular diseases remains central. ,,
| Materials and methods|| |
A simple instrument developed by George NG, a final year medical student in 2012, was used for the procedure. The instrument (Zaria-made Jugulometer) consists of two components: Horizontal and vertical which is coupled before use [Figure 1] and [Figure 2]. Each component possesses unique features as against the plane ruler used in the instrument developed by Ogunlade et al.
The horizontal component consists of the following features:
- Light source: Provides illumination for accurate measurement
- Indicator: Points to the highest level of the jugular venous pulse
- Plumb gauge: Adjustment of the air column in this gauge to the middle segment indicates proper positioning of the horizontal and vertical components before readings are taken.
The vertical component consists of the following features:
- Rubber padding: Ensures non-traumatic contact of the vertical component on the sternal angle and ease of adjustment before measurement
- Scale: Provides calibration for reading of JVP height above the sternal angle.
The jugulometer method of JVP estimation is fast and less cumbersome as demonstrated in [Figure 3].
The study was a prospective study in which 41 consecutive patients with elevated JVP in heart failure were recruited from two centers. JVP was estimated by conventional method (using two rulers) with patient inclined at 45 o to the horizontal. This was repeated using the jugulometer with and without light source separately [Figure 3]. The time taken (in seconds) was noted using a stop watch for each of the three measurements taken as well as the corresponding height of JVP above the sternal angle (in centimeters). Age, sex, BMI, pulse rate, blood pressure and cause of heart failure were also noted.
| Results|| |
Data obtained was analysed using SPSS statistical software (version 16). Using descriptive statistics a total of 41 patients consisting of 21 (51.2%) males and 20 (48.8%) females with a mean age of 39.41 ± 13.79 years were examined. Heart failure was due to cardiomyopathy (17.1%), hypertension (26.8%), MI (2.4%), rheumatic valvular heart disease (41.5%), peripartum cardiac failure (9.8%) and cor-pulmonale (2.4%).
Analysis was done comparing conventional method and instrument without light (pair 1), conventional method and instrument with light (pair 2), and instrument without light and instrument with light (pair 3). Difference in the pairs where compared using the Paired Sample T-Test at P < 0.05 while the generated Pearson correlation co-efficient was used to determine relationship between them. There was a significant positive correlation (r = 0.830,0.830, and 0.954, respectively) in the height of JVP measured (P < 0.000 each). Also the difference seen in the values of JVP height were not statistically significant (P > 0.174, 0.179 and 1.000). On the other hand, time difference (in seconds) for measuring the JVP were found to be statistically significant (P < 0.004, 0.000 and 0.011) and shorter with the jugulometer.
| Discussion|| |
The average age of 39.41 years of patients involved is lower than ages in heart failure studies in Sub-Saharan Africa ,, because more than 50% of the patients had rheumatic heart disease (RHD) and peripartumcardiac failure. Heart failure in this group of patients occur in early adulthood and is still prevalent. , The three predominant causes of heart failure (hypertension, RHD and dilated cardiomyopathy) were consistent with findings in other studies. ,, However, there was a predominance of rheumatic heart disease up to41.5% [Figure 4] due to the criteria for the inclusion to the study.
There was a strong positive correlation in the values of JVP irrespective of the methods used but this was strongest (0.954) when the jugulometer was used with and without the light on. The differences in the measurements taken were not statistically significant. Meanwhile, the time taken to obtain these results were significant at P < 0.004, 0.000 and 0.011. This therefore implies that the time difference in using the conventional two-ruler method and using a jugulometer with light was much more significant at P < 0.000. This finding shows that the quick assessment of patients at the bedside especially in student examination or emergency practice setting when time is very crucial can be enhanced.
| Conclusions|| |
The Zaria-made Jugulometer is faster, less cumbersome and has comparable accuracy to the conventional way of JVP estimation by the bed side. It is therefore recommended for routine patient examination.
| Acknowledgement|| |
Our appreciation goes to all whose goodwill help to make this work a success especially the chief executives and head of medicine department of the institutions used in this study.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]