The ability to assess intravascular volume status is something that clinicians who care for critically ill patients have long been seeking. The jugular vein is one of the central veins of the body, meaning that it is a thin-walled, distensible reservoir that acts as a conduit of blood in continuity with the right atrium . When a patient becomes fluid overloaded, right heart pressure will increase and transmit back to the jugular vein, causing jugular vein distention. Jugular vein distention (JVD) is used as a quick way to assess volume status and cardiac function.

JVD assessments are particularly important for patients with;

Congestive, acute, or right-sided heart failure (especially to monitor the response to diuretic therapy), 

Dialysis - hemodilaysis and peritoneal dialysis,

Pulmonary hypertension,

Superior vena cava obstructions,

Tricuspid valve disease or stenosis, and

Pericardial disease or constriction .

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The number of tools that have been employed in the pursuit for intrasvascular volume monitoring is lengthy and includes techniques such as the Swan-Ganz catheter, central venous pressure monitoring via central venous catheters (CVC), inferior vena cava (IVC) POCUS assessment, arterial pulse contour analysis, esophageal Doppler monitoring and many other  . Clinically, ultrasound is the most commonly used technique in the ICU for checking blood vessel dilation and constriction by measuring the cross sectional area of blood vessels. Many publications have shown that ultrasound measurements of jugular vein distention to assess intravascular blood volume status in the ICU is used to improve patient outcomes  . Each technique has its benefits and downsides, most are either invasive (requiring central venous access or the patient to be intubated), require some degree of specialized skill, cannot provide continuous assessment, and none of these methods are considered to be the holy grail of preload assessment. A tool that is non-invasive, continuous and doesn’t require a high level of technical proficiency would be welcomed by emergency and critical care physicians  .

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Our solution to continuously monitor JVD and intravascular blood volume status

Our VO 100 – Jugular Venous Oximetry is the first system with the capability to noninvasively and continuously monitor the blood volume in the jugular vein. When placed over the jugular vein, the VO 100 can monitor the static blood volume within the jugular vein using a novel parameter called the blood volume index (BVI). BVI shows the blood to tissue volume ratio in the tissue beneath the sensor, in percentage (%). For example, if the reading is 10% then that indicates that 10% of the tissue volume is filled with blood. By continuously monitoring a patient, clinicians can observe the changes in BVI which correlate to the blood vessel distention (which is shown by the increase in blood volume) and constriction (which is shown by the reduction in blood volume). BVI measurements are easily obtained by simply adhering a reusable sensor over the jugular vein. This means that any healthcare professional can now monitor a patient’s intravascular blood volume status in any health care setting.

References​

1. Gopal S, Nagalli S. Jugular Venous Distention (JVD) [Updated 2020 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553098/

2. Chatterjee K. The swan-ganz catheters: past, present, and future. A viewpoint. Circulation. 2009 Jan 6;119(1):147-52.

3. De Backer D & Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care. 2018 Feb 23;22(1):43.

4. Lee CW, Kory PD & Arntfield RT. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound. J Crit Care. 2016 Feb;31(1):96-100.

5. Geerts B, de Wilde R, Aarts L & Jansen J. Pulse contour analysis to assess hemodynamic response to passive leg raising. J Cardiothorac Vasc Anesth. 2011 Feb;25(1):48-52.

6. Roeck M, Jakob SM, Boehlen T, Brander L, Knuesel R & Takala J. Change in stroke volume in response to fluid challenge: assessment using esophageal Doppler. Intensive Care Med. 2003 Oct;29(10):1729-35.

7. Simon M, Schnatz R, Romeo J, Pacella J. Bedside ultrasound assessment of jugular venous compliance as a potential point-of-care method to predict acute decompensated heart failure 30-day readmission. J AM Heart Assoc. 2018;7:e008184.

8. Singh S, Kuschner WG & Lighthall G. Perioperative intravascular fluid assessment and monitoring: a narrative review of established and emerging techniques. Anesthesiol Res Pract. 2011;2011:231493.

Tissue Perfusion 

noninvasive measurement of JVD as an indication of intravascular volume status for critically ill patients

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