Jugular Venous Pulses
Appearance
Inspection
[edit | edit source]- Cyanosis
- Frankly distended external jugular veins
- Periorbital edema
- Neck masses
- Lines/tubes
Procedure
[edit | edit source]- Position the patient with the head on the pillow and sterno cleido mastoid muscles relaxed
- Start with the head of the bed @ 30 degrees. Adjust the bed angle to visualize the JVP in the lower 1/2 of the neck.
- Ask the patient to lift their chin slightly (the traditionally taught method of allowing the head fall to the left mistakenly obscures the pulse beneath a contracted sternocleidomastoid muscle).
- Use tangential lighting, examining both sides of the neck
- Identify the external juglular vein then the internal which pulses through soft tissue.
The 5 ways to distinguish the internal jugular vein (JVP) from the carotid
[edit | edit source]- JVP is not palpable
- JVP is occludable with light pressure above the sternal end of the clavicle
- JVP changes with bed angle
- JVP descends with inspiration
- The JVP is multiphasic while the carotid is monophasic
- Measure the JVP relative to the sternal angle
- > 4cm is abnormal
Components of the JVP
[edit | edit source]- A wave - increase in atrial pressure that reflects atrial contraction (A = Atrial contraction)
- C wave - tricupsid valve closure
- V wave - filling of atrium with tricuspid closed (V = venous filling)
- X descent - atrial relaxation
- X' descent - ventricular emptying pulls down atrium
- y descent - passive flow of blood from atrium to ventricle
Note: The carotid pulsation generally falls over the c wave
Abdomino jugular reflux (AJR)
[edit | edit source]- apply firm pressure to the abdomen for 10 seconds
- normally the JVP will rise transiently then fall back to normal within 10 seconds
- the AJR is positive if the JVP stays elevated for more than 10 seconds then falls to normal when the pressure is removed
- do not do this maneuver if the JVP is already high