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The jugular veins: gateway to the heart

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Inspection of the jugular veins provides a simple means of determining whether pressures in the right side of the heart are normal or elevated. With practice, clinicians can derive accurate and reliable information relevant to diagnosis and patient care.

Identifying a venous pulsation

It is not necessary to position the patient at precisely 45 degrees.1,2 If your patient is in a chair, examine them in that position. If they are on a couch or bed, examine them in the position that you find them.

Explain to the patient why you want to look at their neck. Traditionally, the right side of the neck has been used for jugular vein examination. However, it is often more difficult to see pulsations on the same side as you are positioned and, importantly, it is known that measurements made from the left side of the neck have similar accuracy.3 Further, inspection of the external, rather than internal jugular vein are also of similar accuracy.4 If you do use the ipsilateral side of the neck, try side-lighting with a torch or looking tangentially across the skin, rather than directly at it. Whichever side you use, and whichever vein, there must be visible pulsation at the top of the venous column. If there is no visible pulsation, do not use that vein as a manometer.