H.21 Objective jugular venous pulsation bedside assessment.

Determining a patient’s volume status is vitally important for clinical care and has broad implications to medication administration, length of hospitalizations, mortality, and morbidity. If the wrong assessment is made, patients may inappropriately receive fluids when they are actually severely volume up or vice versa be given a diuretic (aka water pill) when they are actually volume down. There are many tools in the physician’s armoritarium to assist with assessing a patient’s volume but all have poor likelihood ratios and do not reliably answer these questions. One exam maneuver far exceeds the others and is the most accurate way to assess a patient’s volume status and surrogate measure of right sided heart pressures; it is the jugular venous pulsations (JVP). When elevated (to greater than 8 cmH2O) we correlate this with a patient still being volume up and need for additional inpatient stay. However, when inappropriately assessed by the physician, patients run the dangerous risk of being over or under diuresed resulting in organ damage (i.e kidney) or hospital readmission respectively. This assessment is much more challenging than one would think. There are several challenges inhibiting accurate assessment of the JVP. One is confusing the venous pulsations with the arterial one. A second is the inability to accurately find the top of JVP. Another is the patient’s body habitus making direct visualization with the naked eye a challenge. Lastly, there is a lot of discrepancy with regards to accuracy between different levels or experience of providers.

There are no current technologies available on the open market that allow for accurate assessment of the JVP, it is reliant completely on physician expertise and direct visualization. The gold standard for measuring the venous pressures is with an invasive intravenous catheter procedure. A non-invasive hand-held type device that could easily and accurately assess this would provide higher-level clinical care, improve clinical outcomes, and decrease patient hospital length of stay.

The venous pulsations have a very unique well-documented movement signature which could easily allow its differentiation with a computed assisted device/sensor. Also, assessing the pulsation characteristics can also aid in various heart pathology diagnoses. Developing such a technology could be pivotal to patient care in the field of internal medicine and cardiology worldwide.