Jvd?

[stella123 rn]

Is there a good way to assess JVD? I know it may be simple and a stupid question, but I have a major problem with it. We seem to have a lot of fragile patient's that come in with pneumonia or something so there lungs already sound like crap, there O2 sats are not great, or they already have edema. We pump IV fluids into them and I just get concerned. I don't know, I just have a problem with JVD. Are they always flat or distended? Is it ever normal for them to be prominent? I just need suggestions. Thank you. I am still fairly new to nursing and am always looking for good ways to assess things.

[boggle, ASN, RN]

Hi Stella, I had a hard time visualizing JVD for awhile myself. I'd look at the neck and confuse the carotid pulsation/ prominence for the jugular.

Another nurse helped me to get it straight at last by showing me this demonstration:

First, find friend or willing pt who will lay flat for you. Stand at the side of the bed by their head, and bend over or squat to look at the neck at eye level. Have your patient look away from you slightly.

Most people will have distended jugular veins when lying flat. The is a NORMAL finding. It looks like a cord rising from the clavicle toward the jaw.

Now raise the head of the bed to 45 degrees. The vein should disappear. If you can still see it at 45 degrees, you have an abnormal finding...JVD!

I know there is a way to measure just how much distention there is, but I have not learned that. On my job, we just note presence or absence of JVD.

Hope this helps.

[Edward,IL]

Good answer. There is an illustrated lesson and very thorough explanation in the Springhouse Publications text I have. It's about twenty years old now, but is very good at explaining this and measuring central venous pressure using a penlight shining on the patient's neck with the HOB at 45 degrees.

Just my opinion, Edward, IL

[gwenith, BSN, RN]

My only cencern with the very good answer above is a caution about lying the brittle pulmonary oedema patient down. Could find yourself in a lot of trouble very rapidly. We do not measure JVD's we look at the entire patient and treat symptomatically.

[geekgolightly, BSN, RN]

Originally posted by gwenith

My only cencern with the very good answer above is a caution about lying the brittle pulmonary oedema patient down. Could find yourself in a lot of trouble very rapidly. We do not measure JVD's we look at the entire patient and treat symptomatically.

I think your caution is on target, but I also think that the instruction was for a friend to be the guinea pig so that someone could see what is actually JVD and what isn't, in order to note that on a patient when they are 45 degrees.

[dianah, ASN]

Interesting note: In the late 70's I worked w/a cardiologist who would "measure" it with his thumb and pinkie spread out. He'd raise the head of the bed (or lower it, as needed) till he saw the jugular fill, then place his hand (open as described above) on the bed next to the pt, with the thumb lowest (anterior axillary area) -- - and mumble a rough cm measurement! He was a VERY good cardiologist, and a kind man to boot! I never got a chance to get some inservice from him on this method . . .

'Course, back in those days the swans were JUST coming into use; CVP pressures were "IT" for invasive monitoring!