Jugular Venous Pressure (JVP) Measurement

Jugular Venous Pressure (JVP) Measurement II. Objective 1. Find out whether there is jugular venous distension (JVD) 2. Estimating central venous pressure (central venous pressure 3. Distension of the veins in the neck can show changes in volume and pressure in the right atrium. The jugular vein is one of the veins in the neck area. III. Indication Cardiac Problems: 1. Patients who receive heart surgery so it is very important to know the circulation status 2. Patients receiving vasoactive drugs, parenteral nutrition, or if peripheral veins are inadequate 3. Patients with unilateral distension 4. Patients with major trauma 5. Patients whose venous blood is often taken for laboratory test samples 6. Patients who are given IV fluids quickly Non-cardiac problems : 1. Superior vena cava obstruction 2. Increased blood volume 3. Increased intrathoracic pressure up to positive pressure mechanical ventilation, Valsalva maneuver, disease. Airway obstruction, tension pneumothorax 4. Increased intra-abdominal pressure up to pregnancy, obesity, ascites IV. Contraindications 1. SVC syndrome 2. Infection at the insertion area 3. Coagulopathy. 4. Wire insertion: pacemaker 5. Contralateral diaphragm dysfunction 6. Neck surgery V. Aspects to pay attention to 1. Set a comfortable position 2. Make sure the neck and thorax are open 3. Avoid hyperextension or flexion of the neck 4. Assess the patient's level of consciousness VI. Procedure 1. Place the client in a supine and relaxed position. 2. The head of the bed is elevated: - 15° - 30° (Luckman & Sorensen, 1993, p. 1112; Lanros & Barber, 1997, p. 141), or - 30° - 45° (LeMone & Burke, 2000, p. 1188), or - 45° - 90° — in clients who experience a significant increase in right atrial pressure (Luckman & Sorensen, 1993, p 1112). 3. Use a pillow to support the client's head and avoid sharp neck flexion. 4. Encourage the client's head to turn away from the examiner. 5. Remove clothes that are tight/pressure on the neck or upper thorax. 6. Use a flashlight at an angle to see the shadows of the jugular vein. Identify the internal jugular vein pulsation (differentiate this pulsation from the pulsation of the adjacent internal carotid artery), if not visible use the external jugular vein. 7. Determine the highest point where the internal/external jugular vein pulsation can be seen (Meniscus). 8. Use the angle of the sternum (manubrium joint) as a place to measure the height of the venous pulsation. This point is ± 4 – 5 cm above the center of the right atrium. 9. Use a ruler - The 1st ruler is placed vertically, with one end attached to the corner of the sternum. - The 2nd ruler is placed horizontally, where one end is right at the highest point of venous pulsation (meniscus), while the other end is attached to the 1st ruler. 10. Measure the vertical distance (height) between the angle of the sternum and the highest point of venous pulsation (meniscus). 11. Normal value: less than 3 or 4 cm above the angle of the sternum, in a bed position with the head elevated 30° - 45° (Luckman & Sorensen, 1993, p. 1113). 12. Record the results. Writing and Reading Results -For example = 5+2 -5: is the distance from the atrium ka to the corner of the manubrium, and it is a constant - +2: result—meniscus Measurement Results and Interpretation a. Values more than normal indicate increased right atrial/ventricular pressure, for example in: - Right heart failure - Tricuspid regurgitation - Pericardial tamponade b. Values less than normal indicate extracellular volume depletion. c. Unilateral distension, indicating vessel obstruction on one side.