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Who... incorporates
JVD assessment into their
daily practice?
Vein Distention
Assessment
Sternomastoid
Muscle
1.Use the internal jugular
Internal
and External
Carotid Artery
4.Can use
external jugular,
go to point of
pulsation
in distention
2.Up behind the ear,
more lateral (purple)
2
Where to Assess
JVD
3.Do not use the
carotid artery.
-Do not use the carotid artery
-The internal jugular vein is preferred over the external jugular vein as it is more accurate
-When you use the external jugular go to the point of pulsation in the distention
Kussmauls
Sign
Assessment
How to Measure
Central Venous
-Due to increased pressure in the right ventricle, Kussmauls sign can appear
-It is a significant sign in right sided heart failure and in temponade
-Normally on inspiration the jugular pulsation is not visible or is lighter
-In Kussmauls sign on inspiration the jugular pulsation is not only visible but will increase
Pressure
-Measure elevation of neck veins above the sternal angle
Your Turn
-Add 5cm to measurement because the right atrium is 5cm below the sternal angle
Raised CVP > = 7cm H2O
Steps For JVD
Asessment
TIPS for your Assessment
What Are We Looking For...
-The best vein to use is the internal jugular
-Have patient turn their head slightly away from you
-With proper lighting inspect jugular vein on the right side
-Determine the external and internal jugular veins
-Elevate the head of bed 30 degrees. As the HOB is higher the pulsations are harder to see
-Have the patient turn their head but make sure the neck muscles are not tense
-Use a light from behind to create a shadow. This way we can see the pulsations better
-Inspect for pulsations
-To feel the carotid artery, place your finger just inside the sternomastoid muscle.
-Do not use your own thumb to palpate as you will feel your own pulse
-Inspect for 2 pulsations
-Carotid artery has a regular pulse that you can palpate
-The internal jugular can be visualized but cannot be palpated.It looks like a wave pulsation.
...
Why Are We Missing It?
-To estimate jugular venous pressure and pressure of the right atrium identify the highest point of pulsation in the internal jugular vein
Find the sternal angle
-Measure the vertical distance between that point and the sternal angle in centimeters. Add 5 cm to that distance and document
-Document the degree at which the head of the bed is elevated
The Importance
of JVD Assessment
-Indication of patient's current cardiac output and function, specifically filling pressures of the right side of the heart
-acts as a manometer and gives indication of central venous pressure
-avoids invasive measures such as central venous catheters
Who Do We do JVD Assessment On...
-
-All patients with myocardial infarctions, especially in first 24 hours
-Inferior MI's (especially right ventricular infarcts)
-Each day with congestive heart failure and Cardiomyopathies
-Pericarditis
-Cardiac tamponade