Jugular Venous Pressure Measurement

Congestive heart failure is a common and devastating health problem that affects upwards of 23 million individuals worldwide. Optimal medical management is critical for improving symptoms and relies heavily on accurate assessment of the jugular venous pressure (JVP). Assessment of the JVP involves attempting to visualize the height of a column of blood in a neck vein just below the skin. Unfortunately, clinical assessment of the JVP is notoriously challenging to measure and correspondingly inaccurate.

The major difficulties associated with measuring the JVP that result in inaccurate measurements are two-fold: 1) Failing to correctly identify the height of the venous column of fluid along the neck, and 2) Ascertaining the height of the venous column relative to the sternal angle. The use of ultrasound to visualize the internal jugular vein is currently being advocated as a method to identify the maximal height of the venous pulsation along the neck. Multiple reports have emerged in the literature highlighting its feasibility and potentially improved accuracy relative to the current standard of visual identification of the maximal height of the venous column along the neck. Although promising, major limitations include the cost of ultrasound equipment, inability to relate the maximal height to a reference point such as the sternal angle, and its use is often impractical for routine clinical rounds.

The second component of measuring JVP height, ascertaining the height of the venous column relative to the sternal angle, requires vertically orienting a ruler at the sternal angle and extending another straight edge from the ruler to the height of the venous column on the neck (the “2-ruler” method). This technique is cumbersome, difficult to perform, and further complicated by the overwhelming majority of physicians not carrying rulers during clinical rounds. Despite its limitations, although perhaps surprising, it remains the standard of care in 2018. Recognizing its impracticality, which is partially driven by the overwhelming majority of physicians not carrying rulers on clinical rounds, expert cardiologists have suggested alternative approaches, including measuring the height of their fist in centimeters in order to facilitate its use as a surrogate for measuring JVP height.

Despite the challenges associated with measuring the height of the JVP relative to the sternal angle, to date, there have been no solutions that facilitate this task. The proposed device, the JVP-ez (patent pending), overcomes the challenge of quantitatively assessing the height of the JVP relative to the sternal angle. After resting the base of the JVP-ez on the sternal angle, a vertically adjustable light line is projected onto the patients neck at the height of the JVP, enabling the height to be read directly from the device.

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