The central venous pressure (CVP) is an important measurement that reflects the blood pressure in the right atrium or the superior vena cava (SVC). It is most …
Examination of the Jugular Venous Pressure
The central venous pressure, or
CVP, is the pressure within the thoracic
vena cava, just before the right atrium.
The superior vena cava and the
connecting jugular veins act as a column
of blood in which the CVP can be
approximated by determining the jugular
venous pressure. This is done by
measuring the elevation of the neck
veins above the sternal angle ,and
correlating it to the height of the
blood column in centimeters of water. The right-sided internal jugular vein is
best for conducting this procedure, since
it is directly connected to the right
atrium. The exam can also be performed on the external jugular veins but they
often branch at right angles which can
interfere with the test results. However,
in this video, the external veins are
used to perform the examination, since
their superficial course and good
visibility allow for the best
demonstration of the technique. In the
beginning, the patient should be
recumbent, with the head turned slightly
to the left.
The jugular veins are now at the same
level as the right atrium and should be
significantly distended under
physiological conditions.
The jugular vein presents with a regular
pulse featuring a twin peak. The internal
jugular veins pulsations are not readily
observable since it lies deeper within
the neck. Its pulsation, though weak, can be
observed just ventromedial to the
external jugular vein.
The CVP, or the height of the
blood column above the right atrium, can
now be estimated by slowly raising the
patient's upper body by about thirty to
forty-five degrees.
As soon as the distension of the jugular
vein starts to decrease, halt the
movement of the patient's upper body and
locate the most cranial point at which
the jugular vein is still distended.
The vein now functions as a manometer that represents the CVP.
Draw an imagined horizontal line towards
the sternum, starting at the most cranial
point at which the vein is still distended.

Since the sternal angle lies about five
centimeters above the level of the right
atrium, add those five centimeters to the
measured distance.
This sum roughly represents the
patient's CVP, measured in centimeters of
water.
This patient has a CVP of about seven
centimeters of water, which is within the
reference range of four to ten
centimeters of water.
If the sum is greater than 10
centimeters, the CVP is considered too
high, as seen in heart failure,
hypervolemia, or pulmonary embolism.

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