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Defining normal jugular venous pressure with ultrasonography

Published online by Cambridge University Press:  21 May 2015

Steven J. Socransky ,
Ray Wiss ,
Ron Robins ,
Alexandre Anawati ,
Marc-Andre Roy  and
I. Ching Yeung
Steven J. Socransky*
Affiliation:
Emergency Department, Hôpital regional de Sudbury Regional Hospital, Northern Ontario Medical School of Medicine, Sudbury, Ont.
Ray Wiss
Affiliation:
Emergency Department, Hôpital regional de Sudbury Regional Hospital, Northern Ontario Medical School of Medicine, Sudbury, Ont.
Ron Robins
Affiliation:
Emergency Department, Woodstock General Hospital, Woodstock, Ont.
Alexandre Anawati
Affiliation:
Emergency Department, Hôpital regional de Sudbury Regional Hospital, Northern Ontario Medical School of Medicine, Sudbury, Ont.
Marc-Andre Roy
Affiliation:
Emergency Department, Hôpital regional de Sudbury Regional Hospital, Northern Ontario Medical School of Medicine, Sudbury, Ont.
I. Ching Yeung
Affiliation:
Emergency Department, Hôpital regional de Sudbury Regional Hospital, Northern Ontario Medical School of Medicine, Sudbury, Ont.
*
Emergency Department, Hôpital regional de Sudbury Regional Hospital, 700 Paris St., Sudbury ON P3E 3B5; ssocransky@hrsrh.on.ca

Abstract

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Objective:

Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP.

Methods:

We conducted a prospective anatomic study on a convenience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 techniques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV's path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants.

Results:

We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively.

Conclusion:

The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.

Keywords

jugular veinsultrasonographyheart failurecentral venous pressure
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 4 , July 2010 , pp. 320 - 324
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

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