JVP

• Preparation
  • Wash hands
  • Position: supine, 30-45 degrees
  • Expose neck
  • Turn neck to left
  • Relax SCM
• Inspection
  • From R side – look between 2 heads of SCM
  • Look for internal jugular vein – differentiate from carotid
    • Rarely palpable
    • Double waveform
    • Pulsation eliminated by light pressure
    • Descends with inspiration
    • Level varies with position of bed
• Measuring JVP
  • Use 2 rulers
  • Measure height from sternal angle
  • Report “JVP X cm above sternal angle”
• Hepatojugular reflux
  • Abdo pressure for 10 seconds
  • Normal: remains unchanged or increases transiently and returns
  • Abnormal: remains elevated for entire 10 seconds, and falls rapidly when compressing hand released
• Post encounter questions:
  • How do you distinguish between the internal jugular vein and carotid pulse? (6 things)
  • List a cause of a low JVP?
    • Hypovolemia
  • List 2 reasons of an elevated JVP?
    • CHF, renal disease, volume overload

Rational Clinical Exam

• Does this patient have abnormal central venous pressure (1996)