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Showing posts with label JVP. Show all posts
Showing posts with label JVP. Show all posts

How to measure jugular venous pressure?

Jugular Venous Pulse defined as the oscillating top of vertical column of blood in right IJV that reflects pressure changes in Right Atrium in cardiac cycle.
Jugular Venous Pressure is the vertical height of oscillating column of blood
  • The patient should lie comfortably during the examination.
  • Clothing should be removed from the neck and upper thorax.
  • Patient reclining with head elevated 45 °
  • Neck should not be sharply flexed.
  • Examined effectively by shining a light tangentially across the neck.
  • There should not be any tight bands around abdomen
Observe the following
The level of venous pressure.
The type of venous wave pattern.
The level of venous pressure is measured using a centimeter ruler, measure the vertical distance between the angle of Louis (manubrio sternal joint) and the highest level of jugular vein pulsation.The upper limit of normal is 4 cm above the sternal angle.Add 5 cm to measure central venous pressure since right atrium is 5 cm below the sternal angle.
Normal CVP is < 9 cm H2O

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.