Jugular Venous Oxygen Saturation Monitoring
Jugular venous oxygen saturation (SjvO2) monitoring measures the venous oxygenation saturation of blood as it leaves the brain, reflecting the oxygen saturation of blood after cerebral perfusion has taken place. After comparing SjvO2 with the arterial venous oxygenation, you can determine whether blood flow to the brain matches the brain’s metabolic demand.
SjvO2 monitoring is often used with other types of cerebral hemodynamic monitoring—such as intracranial pressure (ICP) monitoring—to provide detailed information regarding pressure and perfusion states during treatment. Treatment regimens can be titrated to enhance pressure and perfusion.
SjvO2 normally ranges from 55% to 70%. Values higher than 70% indicate hyperperfusion; values between 40% and 54% indicate relative hypoperfusion. Values lower than 40% indicate ischemia.
Data from monitoring can also be used to calculate:
cerebral extraction of oxygen (CeO2 = SaO2 − SjvO2)
cerebral arterial oxygen content (CaO2 = 1.34 × Hgb × SaO2 − 0.0031 × PaO2)
global cerebral oxygen extraction ratio (O2ER = SaO2 − SjvO2/Sa2) and jugular venous oxygen content saturation (CjvO2 = 1.34 × Hgb × SjvO2 + 0.0031 × PjvO2)
arteriovenous jugular oxygen content (AVjDO2 = CaO2 − CjvO2), which helps determine cerebral oxygen use, metabolic demand, and adequacy of oxygen delivery.
Monitoring of SjvO2 allows the nurse to maximize the balance between cerebral perfusion, oxygenation, and metabolism. Criteria for SjvO2 monitoring include any neurologic injury in which ischemia is a threat, including intraoperative monitoring, subarachnoid hemorrhage, and postacute head injury with increased ICP.
Equipment
Sterile towels ▪ sterile drapes ▪ surgical caps ▪ gowns ▪ sterile gloves ▪ masks ▪ antiseptic scrub ▪ antiseptic solution ▪ central venous catheter insertion kit ▪ 1% or 2% lidocaine without epinephrine ▪ 5- or 10-mL syringe with an 18G or 23G needle ▪ #5 French percutaneous introducer ▪ #4 French fiber-optic SjvO2 catheter ▪ oximetric monitor with cable ▪ 500 mL of normal saline solution (heparinized or nonheparinized, according to your facility’s policy) ▪ pressure tubing with continuous flush device ▪ pressure bag or device ▪ sterile occlusive dressing ▪ sterile labels.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Explain the procedure to the patient and provide privacy.
Inserting the Catheter
Conduct a preprocedure verification process to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient identifiers.5
Prime the pressure tubing system, removing all air bubbles and maintaining sterility of system for insertion.
Follow the manufacturer’s instructions for in vitro calibration of the catheter before insertion.
Conduct a time-out to make sure that the correct patient, site, and procedure are verified.6
Position the patient with his head elevated 30 to 45 degrees and his neck in a neutral position. Document baseline ICP.7
Turn the patient’s head laterally, away from the site chosen for catheter insertion. Note and document any change in ICP.
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