Jugular Venous Pressure (JVP)

Last updated 26/12/16

Definition

• Assessment of the jugular vein pressure and pulse as part of a cardiovascular assessment

Features

• Preference is to assess right internal jugular vein as it is in a direct line with the superior vena cava and therefore right atrium
• Right external jugular vein second best choice if internal not easily visible
• Hepatojugular Reflux
• Raising legs or abdominal compression increases venous return and pressure
• Facilitates analysis of JVP
• Firm, sustained pressure for 10-15 seconds over upper abdomen during quiet respiration
• Transiently rises JVP by 1-3cm in normal patients
• Right ventricular failure JVP elevation >3cm is sustained
• Diffuclt and commonly poorly performed test
• External jugular vein more easily assessed

Jugular Venous Distension

Indications

• Assessment of volume status

Procedure

• Patient semirecumbent at 30-45o
• Head turned slightly away from side to be examined
• +/- shine a beam of light across neck
• External Jugular Vein
• Runs across Sternoclediomastoid muscle
• More easily visualised than internal jugular
• Placing finger over proximal extent of vein will occlude it and allow it to fill
• Internal Jugular Vein
• Identify venous pulse
• Note height of pulsation above sternal angle
• Alteration of degree of recumbency alters assessment
• Towards 90o if significantly elevated
• Towards supine if significantly reduced
• Measure height of pulsation + 5cm = height
• At 45o sternal angle to right atrium is around 5cm
• Some studies suggest 10cm might be more accurate

Jugular Veins

JVP Measurement

Results

• Jugular Pulsations
• Three positive waves: a, c, v
• Caused by right atrial pressure transmitted to jugular veins during right atrial systole
• a wave peaks immediately prior or during the first heart sound
• c wave interrupts the descent of the a wave due to right ventricular systole
• Generally cannot be distinguished clinically
• v wave at termination of x wave
• Two negative waves: x, y
• x wave in late systole due to delayed pulse transmission and right atrial relaxation
• y wave is the descending limb of the v wave
• Jugular Pressure
• Normal
• 1-8 cmH2O
• 1-6 mmHg
• Reduced: volume depletion or normal
• Elevated
• Congestive Cardiac Failure (CCF)
• Chronic Kidney Disease (CKD)

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References

1. EMS Basics: What it Looks Like: Jugular Vein Distention, 17/10/2011 (Pic)
2. UpToDate: Examination of the jugular venous pulse, B. Gersh, 29/02/2016
3. Buzzle: Internal Jugular Vein Diagram and Functions (Pic)
4. EPO Medicine (Pic)