“JVP not seen”
Am I the only one who has struggled to estimate jugular venous pressure (JVP)? Almost certainly not: scanning patients’ notes I often see “JVP not seen” written by other junior doctors. But why is there such a problem? Probably because much of the teaching we receive on observing JVPs is wrong.
In medical school, when asked by consultants what the correct angle to observe the JVP is, we learnt that the answer that they wanted was 45° to the horizontal. But is this correct?
The JVP is an estimate of central venous pressure. Because the right jugular vein lies directly above the right atrium, it acts as a manometer, displaying the pressure in the right atrium. Traditionally, the height of JVP is measured relative to the sternal angle of Louis, an easily identifiable anatomical landmark which is said to lie 5 cm above the right atrium in patients regardless of