Jugular Venous Pulses

Inspection

• Cyanosis
• Frankly distended external jugular veins
• Periorbital edema
• Neck masses
• Lines/tubes

Procedure

1. Position the patient with the head on the pillow and sterno cleido mastoid muscles relaxed
2. 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.
3. 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).
4. Use tangential lighting, examining both sides of the neck
5. 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

1. JVP is not palpable
2. JVP is occludable with light pressure above the sternal end of the clavicle
3. JVP changes with bed angle
4. JVP descends with inspiration
5. The JVP is multiphasic while the carotid is monophasic
6. Measure the JVP relative to the sternal angle

• > 4cm is abnormal

Components of the JVP

Components of the JVP

• 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)

• 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

Other OSCE modules