Examination of JVP

Introduction Identification Explanation Consent (Chaperone if necessary)

(Patient exposure – top off, semi-supine, 45°, one pillow, head slightly flexed to left)

 Internal jugular vein (IJV) lies directly beneath sternocleidomastoid (SCM) so make sure SCM is relaxed.
 Cast light obliquely across lower neck to identify manubriosternal junction.
 Measure height of the venous pulsation above this junction (normal venous pressure just visible between
the heads of the SCM).
 Inspect between the heads along clavicle for a pulsation then follow along medial border of SCM, any
pulsation = raised JVP.
 Look for “a” – right atrial contraction, “c” and “v” – passive atrial filling waves.
 Hepatojugular reflux – apply pressure to right upper quadrant after making sure pt has no pain, JVP should
elevate for a few seconds, if remains elevated, then right heart failure.

Jugular Vein Carotid Artery JV vs. carotid pulses

Anatomical location In between 2 heads of SCM Medial to JV 1. impalpable

Palpable pulsations? No Yes 2. double waveform

Obliterated by light pressure above

Yes No 3. hepatojugular reflux
the clavicle?

Affected by respiration? Decreased on inspiration No 4. can be occluded

Affected by position? Elevates on lying flat No 5. fill from above

Pulse /beat Two beats per cycle One beat per cycle 6. Location

Prominent (most rapid movement 7. varies with

Non prominent descends Not (most rapid movement outwards)
inwards) inspiration

Abdominal Pressure elevates

Affected by abdominal pressure No effect 8. postural variation
(hepatojugular reflux)