A site for medical students - Practical,Theory,Osce Notes


How to measure Jugular venous pulse (JVP)

Objectives of examination of JVP 
Estimation of jugular venous pressure.
Assessment of wave forms.
Most important bedside test for assessment of volume status.
Assessment of waves give important clues regarding certain conditions.

Internal jugular vein  is preferred because 
It has no valves.
It is in direct line with S uperior vena cava  and right atrium.
Not passing through facial planes, unlikely to be compressed by other structures.
Usually best felt when patient’s trunk is inclined by less than 30.
If pressure is very high, better in sitting position.
If volume depleted, supine is better.

If increased pressure is suspected and pulsations not obtained, make the patient to sit up by the legs dangling over the side of bed. 
Surrogate marker of right sided pressure.
Distance between centre of right atrium and sternal ankle varies in many individuals.
At 40 degree, varies between 6-15cm.
Pulsation above clavicle at sitting position is usually abnormal.
Distance between right atrium  to clavicle is at least 10cm.
Estimation of an elevated pressure is important rather than the exact value.