PCD5, Jugular Venous Pressure (JVP)

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Key Points for JVP Identification

Best assessed from right internal jugular vein pulsations
Internal jugular veins: deep to SCM muscles, not directly visible
Pulsations transmitted to neck surface
Right external jugular vein: alternative but less reliable
Not useful in children under 12 years

JVP Characteristics

Aspect	Description
Dominant movement	Inward (x descent)
Contrast with carotid	Carotid has outward movement
Clinical indications	Volume status, ventricular function, valve patency, pericardial pressures, arrhythmias

JVP Changes in Various Conditions

Decreased JVP: Blood loss, reduced venous vascular tone
Increased JVP: Heart failure, pulmonary hypertension, tricuspid stenosis, AV dissociation, increased venous vascular tone, pericardial issues

JVP Measurement Process

Locate the highest oscillation point in the internal jugular vein or the collapse point of the external jugular vein. Measure the vertical distance above the sternal angle (angle of Louis).

JVP Measurement Positions

graph TD
    A[30° elevation] --> B[JVP not measurable]
    B --> C[Level above jaw]
    D[60° elevation] --> E[JVP measurable]
    E --> F[Top of internal jugular vein visible]
    G[Upright] --> H[JVP barely discernible]
    H --> I[Veins above clavicle]

Note: Venous pressure height from sternal angle is similar in all positions, but measurability varies with patient positioning.

Steps for Measuring JVP

Step	Action
1	Position patient comfortably, slightly raise head to relax SCM muscles
2	Elevate bed/table to 30°, turn patient's head slightly away from inspection side
3	Use tangential lighting, identify external jugular vein, then internal jugular pulsations
4	Adjust bed to see oscillation point in lower neck half
5	Focus on right internal jugular vein, distinguish from carotid pulsations
6	Measure vertical distance from sternal angle to highest pulsation point, add 5 cm for JVP

Distinguishing Internal Jugular from Carotid Pulsations

Characteristic	Internal Jugular	Carotid
Palpability	Rarely palpable	Palpable
Quality	Soft, biphasic, undulating with inward deflection	Vigorous, single outward thrust
Pressure effect	Eliminated by light pressure above clavicle	Unaffected by venous pressure
Positional change	Height changes with position	Height stable with position
Inspiratory effect	Height usually falls	Unaffected

Jugular Venous Pressure (JVP) Assessment

Patient Positioning

Start with head of bed at 30°
Turn patient's head slightly left, then right