Institutional Subscriptions   Individual Subscriptions 
Editors/Authors   Librarians   Newsletter   Site Tour   A-Z Index   About   Contact Us   Help 
Log In | Log In via Athens
 
Disable Autosuggest
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


Topics Discussed: 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

Excerpt: "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:
Subscriber Log In
Username:
Password:
Forgot your username/password?
Or  
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
Copyright © American Medical Association. All rights reserved.  |  JAMA  |  McGraw-Hill Global Education Holdings, LLC.
Privacy Notice. Any use is subject to the Terms of Use and Notice. Additional Credits and Copyright Information.
Your IP address is 54.81.75.69