As the most important feature of the physical exam when attempting to assess volume status in an individual, proper measurement of the jugular venous pressure (JVP) is critical for providing optimal care to heart failure patients. Despite its relevance, accurate assessment of the JVP continues to remain challenging for clinicians, emphasizing the need for new tools and techniques to facilitate its identification and measurement.
As discussed in previous blog posts, there are two key components for JVP assessment: 1) Identification of the maximal height of the biphasic pulsation along the neck, 2) Measurement of this height relative to the sternal angle.
Accurate identification of the biphasic pulsation can be nuanced and tips for doing this successfully are discussed in detail in the blog post “Identifying that elusive JVP.”
Once confident that the maximal biphasic pulsation has been located, attention can be turned to the equally important step of assessing its height above the sternal angle. A value of 2-4cm is considered within normal limits, while values less than 2 cm are indicative of hypovolemia and those greater than 4cm are consistent with hypervolemia or fluid overload. Determination of this value in both an accurate and reproducible manner is important for clinical decision making and tracking patient progress.
Although accurate determination of the height of the JVP above the sternal angle is of critical importance, the mainstay in routine clinical practice for this assessment is visual gestalt. Perhaps not surprisingly, the use of visual gestalt to estimate JVP height has rendered determined values that ideally should be measured to within a single cm, both inaccurate and poorly reproducible. Textbooks have long taught that a more quantitative assessment of the JVP requires 2-rulers aligned perpendicular to one another, however this technique is cumbersome and difficult to perform and correspondingly is seldom used in routine clinical practice.
The JVPez provides an effective solution for accurately and reproducibly measuring the maximal height of the JVP above the sternal angle. Owing to its use of an adjustable light line that projects from the device to the neck, it is able to overcome the need for a second ruler. Following identification of the biphasic impulse, clinicians need only to position the JVPez upright on the sternal angle and then toggle the height of the projected light line to align with the maximal height of the pulsation. Once performed, the precise height of the JVP can be read directly from the graduated markings on the device. Further details on use of the JVPez are provided in the instructional video (link to video).