How is jugular venous distension (JVD) measured?

How to Measure Jugular Venous Distension (JVD)

Jugular venous distension (JVD) should be measured with the patient at 30-45 degrees elevation, observing the highest point of pulsation in the internal jugular vein, and adding the vertical distance from the sternal angle to this point plus 5 cm to determine the jugular venous pressure in centimeters of water. 1, 2

Proper Measurement Technique

• Position the patient at a 30-45 degree angle of elevation to optimize visualization of the jugular vein pulsations 1
• Identify the highest point of pulsation in the internal jugular vein (typically visible in the neck) 3
• Measure the vertical distance from the sternal angle (angle of Louis) to this highest point of pulsation 2
• Add 5 cm to this measurement (representing the approximate distance from the sternal angle to the right atrium) to obtain the jugular venous pressure in centimeters of water 3, 2
• Normal JVP is considered ≤8 cm H₂O above the right atrium 1

Documentation Methods

• When JVD is expressed in centimeters without further description, the number should be recorded as written 3
• When expressed as centimeters above the sternal angle, 5 cm should be added to account for the distance from the sternal angle to the right atrium 3, 2
• In the absence of a numerical estimate, descriptive terms can be used such as "jugular venous distension," "distended neck veins," "halfway to the jaw," or "to the angle of the jaw" - all of which should be recorded as positive for elevated jugular venous pressure 3, 2

Alternative Assessment Techniques

• The hepatojugular reflux test can be performed by applying pressure over the right upper quadrant of the abdomen for 10 seconds while observing for increased jugular venous distension 1
• Ultrasound assessment of the internal jugular vein can provide more objective measurements, especially in difficult cases 4, 5
• Observing for inspiratory collapse of jugular veins - if the jugular vein collapses during deep inspiration, this suggests normal right atrial pressure 6
• For simplified assessment, a visible jugular venous column above the clavicle in the sitting position has 65% sensitivity and 85% specificity for elevated central venous pressure (>8 mm Hg) 7

Common Pitfalls and Challenges

• JVD measurement can be difficult in obese patients or those with respiratory disorders 1, 2
• Apparent JVD may be confused with carotid pulsations; jugular venous pulsations are obliterated by light pressure at the base of the neck 2
• Complete normalization of JVP may not be appropriate in all patients, particularly those with pulmonary hypertension or tricuspid regurgitation 1
• Reliability of JVP assessment varies between clinicians and requires practice for accurate measurement 1

Clinical Significance

• JVP reflects right atrial pressure and is an important indicator of volume status in heart failure patients 1, 2
• Elevated JVP is associated with increased risk for heart failure hospitalization and poor prognosis 1
• A lower jugular vein distensibility ratio (maximum diameter during Valsalva to diameter at rest) is associated with higher NT-proBNP levels and worse outcomes in heart failure patients 4, 5
• For right ventricular function assessment, internal jugular vein respiratory variation <30% has 76% sensitivity and 73% specificity for impaired right ventricular function 8