Jugular Venous Pulses

Inspection

 * Cyanosis
 * Frankly distended external jugular veins
 * Periorbital edema
 * Neck masses
 * Lines/tubes

Procedure

 * 1) Position the patient with the head on the pillow and sterno cleido mastoid muscles relaxed
 * 2) Start with the head of the bed @ 30 degrees. Adjust the bed angle to visualize the JVP in the lower 1/2 of the neck.
 * 3) Ask the patient to lift their chin slightly (the traditionally taught method of allowing the head fall to the left mistakenly obscures the pulse beneath a contracted sternocleidomastoid muscle).
 * 4) Use tangential lighting, examining both sides of the neck
 * 5) Identify the external juglular vein then the internal which pulses through soft tissue.

The 5 ways to distinguish the internal jugular vein (JVP) from the carotid

 * 1)  JVP is not palpable
 * 2)  JVP is occludable with light pressure above the sternal end of the clavicle
 * 3)  JVP changes with bed angle
 * 4)  JVP descends with inspiration
 * 5)  The JVP is multiphasic while the carotid is monophasic
 * 6)  Measure the JVP relative to the sternal angle
 * > 4cm is abnormal

Components of the JVP
Components of the JVP
 * A wave - increase in atrial pressure that reflects atrial contraction (A = Atrial contraction)
 * C wave - tricupsid valve closure
 * V wave - filling of atrium with tricuspid closed (V = venous filling)
 * X descent - atrial relaxation
 * X' descent - ventricular emptying pulls down atrium
 * y descent - passive flow of blood from atrium to ventricle

Note: The carotid pulsation generally falls over the c wave

Abdomino jugular reflux (AJR)

 * apply firm pressure to the abdomen for 10 seconds
 * normally the JVP will rise transiently then fall back to normal within 10 seconds
 * the AJR is positive if the JVP stays elevated for more than 10 seconds then falls to normal when the pressure is removed
 * do not do this maneuver if the JVP is already high