2.Jvp.pptx physiology lecture on jugular venous pressure.

Jugular venous pressure.

1. JUGULAR VENOUS PRESSURE /(Skill lab)

2. At the end of skill lab, all the students of 1 st year MBBS should be able to: Perform the steps of measuring Jugular venous pressure on the given subject Narrate your observation of JVP obtained from given subject Learning Objectives

3. The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein DEFINITION

4. Jugular venous pulse used in determination of: Mean venous pressure Venous pulse contour Presence and type of cardiac arrhythmias Significance

5. We use right external and internal jugular veins for measuring JVP because of direct course of the right jugular veins with the heart as compared to the left external and internal jugular veins Thus the wave form generated by phasic flow to the right atrium is accurately reflected in the jugular vein We prefer internal jugular vein preferably because it lies anterior to external jugular veins Physiological Anatomy

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7. Mean right atrial pressure is normally 9 cmH 2 sternal angle is approximately 5 cm above the right atrium, the normal jugular venous pulse should not extend more than 4 cm above the sternal angle (normal = 6-9 cm) When a healthy subject sits upright the pulse is hidden behind the clavicle and sternum and when the patient reclines at 45° the upper limit of the JVP is at the level of the clavicle Normal Jugular Venous Pressure

8. Both the right jugular veins are in line with the right atrium they can act as the manometer of right atrium , providing valuable information about the changes in right atrial pressure, which represents the Central Venous pressure.

9. Wave Form

10. Task: Examine the JVP of the subject  Requirements: Subject Observer Couch Covering sheet Screen Ruler scale (cm/mm) procedure

11. Exposure Position Light source Location of the venous pulse Differentiate between arterial and venous pulses procedure

12. Position the patient reclining supine at 45° in good light Ensure that the neck muscles are relaxed by resting the back of the head on a pillow Look across the neck from the right side of the patient Identify the internal jugular pulsation (if necessary use the abdominojugular reflux) Examination Sequence

13. Venous pulses must be differentiated from arterial ones Estimate the vertical height in centimeters between the top of the venous pulsation and the sternal angle to give the venous pressure A horizontal line is drawn from this estimated highest point to intersect a vertical line, which is erected perpendicular to the ground through the sternal angle of Louis The distance between the sternal angle and this intercept is measured If necessary, readjust the position of the patient until the waveform is clearly visible

14. Height of the jugular venous pressure, measured in centimeters of water , above the midpoint of the right atrium Moreover, the midpoint of the right atrium is at a constant fixed relationship (i.e., 5 cm) below the sternal angle of Louis regardless of the patient's anatomic position Height of The Jugular Venous Pressure

15. Hepatojugular Reflux: persistent pressure over the liver for 10 seconds while observing the mean jugular venous pressure causes sustained increase in the mean venous pressure until abdominal compression is released This response is called hepatojugular reflux

16. A low JVP suggests dehydration JVP Abnormalities