JU G U LAR VEN O U S PRESSU REDonne Lumban Gao|uguar venous puse s the oscatng top of the the dstended proxma porton of the nterna |uguar ven and represents voumetrc changes that fathfuy reect thepressure cahnges n the rght heartRght atra pressure durng systoe and rght ventrcuar ng pressure durng dastoeWndownto the rght heart, provdng crtca nformaton regardng ts hemodynamcs.1. Anatomy2. |V pressuremeasurement3. Causes of eevated |VP4. Norma wave pattern5. Abnorma wave pattern6. Kussmau s sgn and hepato|uguar reux7. Specc condtonsJugular veinsInterna |uguar venExterna |uguar venwww.ottawaheart.ca-www.physcaexam.med.uaberta.caLateral to carotid artery & deep to sternomastoid muscle.External jugular is superfcial to sternomastoid www.nursesearnng.com-crashngpatent.comwww.freewebs.comthe-heathy-ve.bogspot.com-www.n|monne.nmarred2medcne.hubpages.com-Exam ination of JVPRght I|V s usuay assessed both for waveform and estmaton of venous pressureTransmttedpusatons to overyng skn between two heads of sternocedomastodRight IJV Preferred :W hy?Straght ne course through nnomnate ven to the svc and rght atrum Less key extrnsc compresson from other structures n neckWhy not E|VNo or ess numbers of vaves n I|V than E|V It s preferabe to examne the nterna rather than externa |uguar vens snce the nterna |uguar vens are n a drect ne wth the superor vena cava and rght atrum whereas the externa |uguar vens are not n a drect ne wth the superor vena cava and connect wth t after negotatng two amost 90 degree anges Diff erences bet een IJV and !arotid "ulsesSuperca and atera n the neck Better seen than fet Has two peaks and two troughsDescents >obvous than crestsDgta compresson aboshes venous puse |uguar venous pressure fas durng nspratonAbdomna compresson eevates |uguar pressure Deeper and meda n the neckBetter fet than seenHas snge upstroke onyUpstroke brsker and vsbe Dgta compresson has no ehect Do not change wth respratonAbdomna compresson has no ehect on carotd puse

Estim ation of Venous Pressure Measurng |uguar venous pressure Hepato|uguar reux Examnng the vens on the dorsum of the hand Assessment of |uguar venous pressure at bed sde reect mean rght atra pressure# easurem ent of JV PressureSterna ange or ange of Lous - reference pontFound approxmatey 5 cm above the center of the rght atrum Sterna ange - RA Fxed reatonshpPosition of PatientPatent shoud e comfortaby and trunk s ncned by an ange Eevate chn and sghty rotate head to the eft Neck and trunk shoud be n same neWhen neck musces are reaxed ,shne the ght tangentay over the skn and see pusatons Smutaneous papaton of theeft carotd arteryor apca mpuse ads n tmng of the venous pusatons n cardac cyce .# easurem ent of JVPTwo scae method s commony used Normay |V pressure does not exceed 3- 4 cm above the sterna ange Snce RA s approxmatey 5 cm beow the sterna ange , the |uguar venous pressure corresponds to 9 cm =7mmhgEevated |VP : |VP of >4 cm above sterna ange . Elevated JVP Increased RVP and reduced compance: Pumonary stenoss Pumonary hypertenson Rght ventrcuar faure RV nfarctonRV now mpedance: Trcuspd stenoss / atresa RA myxoma Constrctve percardtsElevated JVP Crcuatory overoad : Rena faure Crrhoss ver Excessve ud admnstratonSVC obstructon $ussm aul%s signMean |uguar venous pressure ncreases durng nspratonConstrctve percardts Severe rght heart faure RV nfarcton Restrctve cardomyopathy Impared RVcompance.&bdom inal 'Jugular Refl ux Hepato|uguar reux - Rondot (1898)Appy rm pressure to perumbca regon 15 secNormay |V pressure rses transenty to < 1cm whe abdomna pressure s contnuedIf |V pressure remans eevated >1cm unt abdomna pressure s contnued: Postve A|R. Abdomna compresson forces venous bood nto thorax.A fang/dated RV not abe to receve venous return wthout rse n mean venous pressure.Postve A|RIncpent and or compensated RVF Trcuspd regurgtaton COPD(orm al JVPNorma |VP reects phasc pressure changes n RA durng systoe and RV durng dastoe Two vsbe postve waves ( a and v) and two negatve troughs ( x and y)Two addtona postve waves can be recorded C wave nterrupts x descent and h wave (orm al JVP|VP devauas tngg dan karakternya.Tngg |VP ebh dar 3 cm H2O merupakan tanda penngkatan tekanan atrum kanan. Norma berksar 5+/- 2 cm H2O!ara JVPMemnta pasen tdur terentang sedemkan rupa sehngga kepaa membentuk sudut 30 dan 450 dengan tempat tdur.Memnta pasen menggerakan kepaa ke arah krMenekan vena |uguars pada bagan dsta agar vena |eas meebarMenekan vena tersebut d bagan krana setngg sudut rahang sehngga aran darah ke |antung berhentMemnta pasen untuk nspras daamMenetapkan ttk pengosongan vena |uguars pada waktu nspras daam dan dber tanda dengan pens asMembuat sebuah bdang datar dengan penggars meau anguus Ludovc (nsers dua ga pada sternum) se|a|ar dengan antaMengukur |arak ttk pengosongan vena |uguars dengan bdang datar tersebut dengan pengars an yang detakan tegak urus terhadap budang datar tadMeaporkan has pengukuran tekanan vena, d atas ttk pengosongan men|ad 5+A, d bawah ttk pengosongan men|ad 5-AThankyou...