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Jugular venous pressure reflects filling volume and pressure on the right side of the heart.
Jugular veins act like manometers; blood in the jugular veins assumes the level that corresponds
to the right arterial pressures. The normal jugular venous pressure is less than 9 cm H2O. the
right internal jugular vein provides the most accurate reflection of right heart hemodynamic
because it is in an almost straight line with the in nominate vein and the superior vena cava. It
lies deep to the sternocleidomastoid muscle, however, the pulsations are usually transmitted to
the skin. The top level of skin pulsation is recorded as the jugular venous pressure. If the right
internal jugular vein is not visible, the right external jugular vein may be used to measure jugular
venous pressure, although it is more subject to thrombosis or compression, and the presence of
venous valves may make the data less reliable.
To measure the jugular venous pressure, follow these steps
Begin with the patient supine, the head and trunk should be in a straight line without
significant flexion of the neck.
Position the patients backrest so that the jugular meniscus can be seen in the lower half
of the neck. Elevating the backrest 15 to 30 degrees above horizontal is usually sufficient.
Visualize the right internal jugular vein and identify the level of peak excursion. If the
external jugular vein is used, identify the level at which it appears collapsed.
Place a ruler vertically in the sterna angle (angle of Louis). Position a straight edge (e.g.,
tongue blade) horizontally is usually sufficient.
If the top of the neck veins is more than 3cm above the sterna angle, venous pressure is
abnormally elevated. Elevated venous pressure reflects right ventricular failure (and is a late
finding in left ventricular failure), reduced right ventricular compliance, pericardial disease,
hypervolemia, tricuspid valve stenosis, and obstruction of the superior vena cava.

During inspiration, the jugular venous pressure normally declines, although the amplitude of the
a wave may increase. With the patient in the horizontal positon, if the neck vein collapse on deep
inspiration (intrathoracic pressure of -5cm H2O) , the central venous pressure is less than 5 cm