Jugular Venous Pressure (JVP) Measurement – Physical Exam

A beginner’s guide to measuring the JVP — perfect for the medical student on their first placement. Far from comprehensive, but an excellent starting point if you’re not quite sure what approach to take. Part of our series on basic clinical examination.

JUGULAR VENOUS PRESSURE EXAMINATION:

The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.

SOME OF THE CAUSES OF JUGULAR VENOUS DISTENTION (JVD):

• Congestive heart failure (CHF)
• Pericardial tamponade
• Constrictive pericarditis
• Chronic pericardial effusion
• Tricuspid stenosis
• Tricuspid regurgitation

THE TECHNIQUE FOR EXAMINATION FOR CVP (CENTRAL VENOUS PRESSURE):

1. Patient reclining with head elevated 45°

– Measure elevation of neck veins above the sternal angle.
– Add 5 cm to measurement since right atrium is 5 cm below the sternal angle.

Normal CVP ≤ 8 cm H2O

2. Light should be tangential to illuminate highlights and shadows.

3. Neck should not be sharply flexed.

4. Using a centimeter ruler, measure the vertical distance between the angle of Louis (manubrio sternal joint) and the highest level of jugular vein pulsation. A straight edge intersecting the ruler at a right angle may be helpful.

5. If the internal jugular vein is not detectable, use the external jugular vein. The internal jugular vein is the preferred site.

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Music:

Brittle Raille by Kevin Macleod
Cool Vibes by Kevin Macleod
Dub Feral by Kevin Macleod
Local Forecast by Kevin Macleod
Groove Grove by Kevin Macleod

(all via the wonderful Incompetech.com)

Special thanks to Harrison Ferguson

Disclaimer:

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