Jugular Venous Pressure
The Jugular Venous Pressure (JVP) is a key measure of fluid status. The normal JVP is 3-4 cm above the sternal angle. A low JVP suggests dehydration, while an increased JVP can be present in fluid overload.
Measuring the JVP
Begin by having the patient lie down with head elevated 30-45 degrees. However, a hypovloemic patient may need to lie flat for JVP to be observable.
The internal jugular vein lies between the two heads of the sternocleidomastoid. They can be brought out by gently resisting head turning.
Sincere appreciation to Dr. Brian Moses for help. Used with permission. |
To discriminate external jugular vein from the carotid:
Check both sides for internal consistency. |
About the JVP
As the right atrium pumps, blood backs up through the superior vena cava, brachiocephalic veins, and jugular veins.
Measuring the level of blood backflow in the internal jugular vein therefore provides a measure of the pressure in the right atrium.
Elevated JVP suggests fluid backup from the right heart, and can accompany heart failure, tricuspid valve disease, pulmonary stenosis, or pericardial diseases.
Kussmaul's Sign is an increase in JVP upon inspiration, instead of the normal decrease. It suggests right heart malfunction, such as can be seen or pulmonary hypertension or COPD.