How To: JVP

 How To: JVP

It was great to receive a refresher on how to do the JVP examination during my rotation. We all know how to do the basic steps, but breaking each step down even further helped me better understand how the JVP is used and what it can tell us.

One: Identify the JVP

In comparison to the carotid pulse, the JVP can be distinguished by six unique features.

1. Location is between the two heads of the sternocleidomastoid muscles

2. Multiphasic waveform

3. Not palpable

4. Occludable

5. Changes with position and respiration - decrease with respiration

6. Changes with abdominojugular reflux maneuver

Two: Absolute Height

A normal JVP is <4cm. An elevated JVP is suggestive of volume overload, but more specifically, poor RV compliance.

Three: Abdominojugular Reflux

This maneuver is performed by applying 20-30mmHg of pressure to the patient’s abdomen. A normal response is an elevation of the JVP 2-4cm above the baseline level, and return to baseline within 10 seconds. A 2cm (70% specificity)/4cm (90% specificity) AND sustained elevation >10 seconds are required for a positive AJR exam.

Four: Waveform Analysis

Ascent

a: atrial contraction

c: bulging of tricuspid with ventricular contraction

v: passive atrial filling

cv: specific for tricuspid regurgitation

Descent

x’: downward movement of tricuspid with ventricular contraction

y: atrial emptying with opening of tricuspid

-BH-

Reference:

1. Harvey teaching

2. Drawing by me