JVD

[hammerpcp]

JVD. Why must it assessed with pt sitting at 45 degree angle? I can't get a straight answer out of anybody. Is this just an arbitrary number or what? Share your wisdom. BTW.. I do understand why it can't be assessed with pt supine, but why not with pt sitting?

[akflightmedic]

Best I can tell in my simple words is that is the standard by which they use to ensure accuracy when measuring JVD.

Peripheral assessment is another crucial indicator of the progression of congestive heart failure. Dependent body parts (legs, feet, sacrum, and back) become edematous, as the left ventricle is no longer able to pump blood sufficiently, leading to the back up of blood into the peripheral venous circulation. There can also be seepage of fluid from these areas with pressure application. In severe cases, periorbital swelling (of the eyelids) occurs as well (Smeltzer, et al. 1994). As this build-up of volume occurs, jugular vein distension can be observed. The patient is elevated to a 45 degree angle, and the estimated distance between the angle of Louis and the level of the jugular vein distension is estimated. Any measurement greater than 3 cm is abnormal. Lastly, hepatojugular reflux is another indicator of peripheral congestion. The patient is made to breath normally while manual pressure is applied over the liver for 30-60 seconds. If neck distension increases greater than 1 cm, this is a positive test for increased venous pressure (Smeltzer, et al. 1994).

This one has a nice graphic for ya...

http://classes.kumc.edu/son/nurs352/Module_5/jvd.htm

[Doczilla]

If the patient is totally upright when JVD is measured, there are several cm of the venous system that are still in the chest, so you may potentially miss a milder JVD. When the patient lies down, the entire jv is at the level of the atrium, so the whole thing will be distended. At 45 degrees, you can measure JVD almost from the level of the right atrium.

Note, though, that you don't measure along the jv. Draw an imaginary line horizontally from the end of the JVD to a point above the sternum. Measure the vertical distance between this line and the sternal angle (angle of Louis) to estimate the JVD and, by extension, the central venous pressure. There's a very nice graphic of this in the link posted by ak.

'zilla

[Ridryder 911]

Good posts guys... I have so many Paramedics that actually do not kow how to measure EJVD appropriately or know what the normal is. Yes, engorged EJ is clinically significant, but is not the same as EJ distention.

Be sure to note on your PCR of measurement as well. Such as EJVD @ 6cm in height @ 45[sup:81c3fbd8aa]o[/sup:81c3fbd8aa] angle.

Be safe,

R/r 911

[hammerpcp]

Thanks for the replies guys. Follow up question....So if the pt has JVD while sitting at 90 degree angle it is indicative of relatively more severe back up, so to speak? Meaning right heart failure or pulmonary HTN etc etc.