Neck & Veins Examination
Techniques: Jugular Venous Pressure Measurement (JVP)
The technique for examination for CVP (central venous pressure)
- Patient reclining with head elevated 45 °
- Measure elevation of neck veins above the sternal angle (Lewis Method).
- Add 5 cm to measurement since right atrium is 5 cm below the sternal angle.
Normal CVP <= 8 cm H2O
Light should be tangential to illuminate highlights and shadows.
Neck should not be sharply flexed.
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.
Note: Ability to measure jugular venous pressure will be difficult if pulse is >100 per minute.
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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Distinguishing the internal jugular vein pulsations from the carotid artery
|No pulsations palpable.
|Pulsations obliterated by pressure above the clavicle.
||Pulsations not obliterated by pressure above the clavicle.
|Level of pulse wave decreased on inspiration; increased on expiration.
||No effects of respiration on pulse.
|Usually two pulsations per systole (x and y descents).
||One pulsation per systole.
||Descents not prominent.
|Pulsations sometimes more prominent with abdominal pressure.
||No effect of abdominal pressure on pulsations.
Proceed to the next technique