The Rational Clinical Examination
David L. Simel, Drummond Rennie
Abnormal Central Venous Pressure
Deborah J. Cook, David L. Simel
Distinguishing Arterial (Carotid) From Venous (Jugular) Pulsation
abdominojugular reflex test, central venous pressure, measurement of, central venous pressure-biological function, diagnostic process, jugular venous pulse, paradoxical inspiratory filling of neck veins, vein of neck
"The right internal jugular vein should be used to assess CVP for
several reasons. It is in direct line with the right atrium, thereby
favoring unimpeded transmission of atrial pulsations and pressure.
Clinical assessment of CVP on the left may be marginally higher
than that on the right. Finally, constricted or tortuous external
jugular veins may introduce inaccuracy. Proper positioning is crucial for examination of the neck veins.
The patient's head is supported to relax the neck muscles,
and the trunk is inclined at an angle that brings the top of the
column of blood in the internal jugular vein to a level above the
clavicle but below the angle of the jaw; in normal subjects, this
positioning is accomplished at 30 to 45 degrees above the horizontal.
In patients with elevated venous pressure, it often is necessary
to elevate the trunk beyond 45 degrees, and patients with severe
venous congestion may have to stand up and inspire deeply to bring
the meniscus down into view. In some cases, the level of venous
pulsation will be seen behind the angle of the jaw or will appear
to move the earlobes. If the pressure in the internal jugular vein is
high, venous pulsations will be lost in the completely full vein,
and the high venous pressure may be overlooked...."
Log in to read the full chapter:
Get full access to JAMAevidence two ways:
Subscribe to JAMAevidence
JAMAevidence is a subscription-
based website dedicated to the learning, teaching, and practicing of evidence-based medicine.
Pay Per View
Timed access to all of JAMAevidence
24 hours for $34.95
48 hours for $54.95