Jugular Venous Distention

Jugular Venous Distention

Pressure in the jugular veins reflects right atrial pressure (RAP) and provides the nurse with an indication of heart hemodynamics and cardiac function. The height of the level of blood in the right internal jugular vein is an indication of RAP because there are no valves or obstructions between the vein and the right atrium.

The internal jugular veins are not directly visible because they lie deep to the sternomastoid muscles in the neck (Fig. 17-1). The goals of the examination are to determine the highest point of visible pulsation in the internal jugular veins, to note the level of head elevation, and to measure this point of visible pulsation as the vertical distance above the sternal angle. The patient is positioned supine in the bed with the head of the bed elevated 30, 45, 60, and 90 degrees. The patient is examined at each elevation with the head slightly turned away from the examiner. The nurse uses tangential light to observe for the highest point of visible pulsation.

Next, the angle of Louis is located by palpating where the clavicle joins the sternum (suprasternal notch). The examining finger is slid down the sternum until a bony prominence
is felt. This prominence is known as the angle of Louis. A vertical ruler is placed on the angle of Louis. Another ruler is placed horizontally at the level of the pulsation. The intersection of the horizontal ruler with the vertical ruler is noted, and the intersection point on the vertical ruler is read.

Normal jugular venous pulsation should not exceed 3 cm above the angle of Louis. See Figure 17-2 for an illustration of the procedure for assessment of jugular venous pressure. A level more than 3 cm above the angle of Louis indicates an abnormally high volume in the venous system. Possible causes include right-sided heart failure, obstruction of the superior
vena cava, pericardial effusion, and other cardiac or thoracic diseases. An increase in the jugular venous pressure of more than 1 cm while pressure is applied to the abdomen for 60 seconds (hepatojugular or abdominojugular test) indicates the inability of the heart to accommodate the increased venous return.