Assessment of the JVP can provide insight into the patient’s fluid status and central venous pressure.
Because of the inability to easily visualise the IJV, it’s tempting to use the external jugular vein (EJV) as a proxy for assessment of central venous pressure during clinical assessment. However, because the EJV typically branches at a right angle from the subclavian vein (unlike the IJV which sits in a straight line above the right atrium) it is a less reliable indicator of central venous pressure.
The hepatojugular reflux test involves the application of pressure to the liver whilst observing for a sustained rise in JVP.
In healthy individuals, this rise should last no longer than 1-2 cardiac cycles (it should then fall).
If the rise in JVP is sustained and equal to or greater than 4cm this is deemed a positive result.
As well as providing information on right atrial pressure, the jugular vein waveform may provide clues to underlying valvular disease. A non-pulsatile JVP is seen in superior vena caval obstruction. Kussmaul's sign describes a paradoxical rise in JVP during inspiration seen in constrictive pericarditis.
6-8 cmH20 (4.4-5.8 mmHg)
The jugular venous pulsation has a biphasic waveform.
5 components:
The " a " wave corresponds to right Atrial contraction and ends synchronously with the carotid artery pulse. The peak of the 'a' wave demarcates the end of atrial systole.