Jugular Venous Pressure

The jugular venous pressure (JVP) provides an indirect measure of central venous pressure. The internal jugular vein connects to the right atrium without any intervening valves - thus acting as a column for the blood in the right atrium. The JVP consists of certain waveforms and abnormalities of these can help diagnose certain conditions.¹ Unfortunately, detection of these abnormalities and even the JVP itself, can be difficult and has also been superseded by other diagnostic methods.

• Use the right internal jugular vein (IJV).
• Patient should be at a 45° angle.
• Head turned slightly to the left.
• If possible have a tangential light source that shines obliquely from the left.
• Locate the surface markings of the IJV - runs from medial end of clavicle to the ear lobe under medial aspect of the sternocleidomastoid.
• Locate the JVP - look for the double waveform pulsation (palpating the contralateral carotid pulse will help).
• Measure the level of the JVP by measuring the vertical distance between the sternal angle and the top of the JVP. Measure the height - usually less than 3 cm.

For a diagram see⁵

• This can help confirm that the pulsation is caused by the JVP
• Firm pressure is applied to the right upper quadrant using the palm of the hand
• A transient increase in the JVP will be seen in normal patients
• There may be a delayed recovery back to baseline which is more marked in right ventricular failure

• Heart failure
• Constrictive pericarditis (JVP increases on inspiration called Kussmaul's sign)
• Cardiac tamponade
• Fluid overload e.g. renal disease
• Superior vena cava obstruction (no pulsation)

An elevated JVP in patients with heart failure is associated with an increased risk of hospital admission, death and subsequent hospitalisation for heart failure.⁷ Therefore appreciation of this sign can be clinically helpful.