From the Guidelines
Jugular venous distension (JVD) is documented by measuring the vertical height of venous pulsation above the sternal angle, with the patient positioned between supine to sitting, and noting the distance in centimeters for jugular pulsations above or below the sternal angle, as described in the American Heart Association guidelines 1.
Key Points for Documenting JVD
- Position the patient between supine to sitting to visualize the top of the venous pulsation
- Measure the vertical height of venous pulsation above the sternal angle
- Note the distance in centimeters for jugular pulsations above or below the sternal angle
- Adjust the distance added based on the position of the patient used to visualize venous pulsation
Management of JVD
- Focus on treating the underlying cause, such as heart failure, volume overload, or cardiac tamponade
- For heart failure, treatment may include diuretics, ACE inhibitors, and beta-blockers, as well as fluid restriction and monitoring of weight and vital signs 1
- For volume overload from renal failure, dialysis may be necessary
- Cardiac tamponade requires urgent pericardiocentesis
Importance of JVD Documentation
- JVD serves as an important clinical marker for right-sided cardiac function and overall volume status
- Accurate documentation of JVD is essential for ongoing patient assessment and treatment monitoring
- Clinicians should note the height in centimeters, patient position, presence of hepatojugular reflux, and associated symptoms like dyspnea or edema when documenting JVD 1
From the Research
Documentation of Jugular Venous Distension (JVD)
- JVD is documented by assessing the height of the jugular venous pulse, which is an indicator of right atrial pressure 2, 3.
- The presence and extent of JVD are used to identify the severity of heart failure exacerbation, with higher JVD associated with increased risk of short- and long-term mortality 2, 3.
- JVD is often measured in centimeters of water (cmH2O) and is considered elevated if it is greater than 12 cmH2O 3.
Management of JVD
- Diuretic therapy is commonly used to manage JVD and relieve congestive symptoms of heart failure 4, 5.
- Loop diuretics, such as furosemide and torasemide, have been shown to induce venodilation and reduce JVD 6.
- The use of diuretics in congestive heart failure requires careful monitoring of electrolyte levels, renal function, and diuretic resistance to minimize complications 5.
Clinical Outcomes
- The presence of JVD and peripheral edema has been associated with worse clinical outcomes in patients with acute heart failure, including increased risk of all-cause mortality and longer hospital length of stay 4.
- The combination of JVD and peripheral edema identifies a high-risk cohort for poor clinical outcomes, with an adjusted 24% increase in risk for all-cause mortality at 30 days 4.