Documentation of Jugular Venous Distension (JVD)

Proper Measurement Technique

The American Heart Association recommends that jugular venous distension (JVD) should be documented as the estimated height of the mean jugular venous waveform above the right atrium in centimeters of water 1
When JVD is expressed in centimeters without further description, the number should be recorded as written, as recommended by the American College of Cardiology 1
When expressed as centimeters above the sternal angle, 5 cm should be added to account for the approximate distance from the sternal angle to the right atrium, according to the American Heart Association 1, 2

In the absence of a numerical estimate, descriptive terms can be recorded as positive for elevated jugular venous pressure, such as "Halfway to the jaw", as noted by the American College of Cardiology 1
The hepatojugular reflux (HJR) should be noted if present, as it provides additional information about elevated right-sided pressures, as recommended by the American Heart Association 1, 2

JVD is the most reliable sign of volume overload and reflects right atrial pressure, according to the European Society of Cardiology 4, 2
Proper documentation of JVD is critical for assessing volume status in heart failure patients, as noted by the European Society of Cardiology 5
The presence of JVD has high sensitivity (81%), specificity (80%), and predictive accuracy (81%) for detecting elevated pulmonary capillary wedge pressure (≥18 mmHg), as reported by the European Society of Cardiology 5

JVD measurement can be challenging in obese patients or those with respiratory disorders, as noted by the American College of Physicians 2, 3
Apparent JVD may be confused with carotid pulsations; jugular venous pulsations are obliterated by light pressure at the base of the neck, according to the American Heart Association 4