Inspection of Neck Veins

he bedside examination of neck veins can provide valuable diagnostic information about a patient’s cardiopulmonary status. An inspection of the neck veins involves an evaluation of their physical appearance, an analysis of the venous pulse, and an estimation of central venous pressure (CVP). The right internal jugular vein is typically the best neck vein to inspect in most patients. Jugular venous contours and the presence of jugular venous distention can provide information about underlying cardiopulmonary diseases. For example, the finding of jugular venous distention is highly sensitive and specific in the assessment of left heart pressures in patients with congestive heart failure. 1 Moreover, an estimation of CVP, which reflects cardiac function, can be made by way of a determination of jugular venous pressure 2 ; an estimation of CVP and an analysis of the jugular venous pulse provide information mainly about physiologic events in the right atrium and right ventricle of a patient’s heart. This article briefly reviews anatomic considerations relevant to the jugular veins and discusses characteristics of the jugular venous pulse, jugular venous pressure, and CVP. It also describes methods of examining the pulse of the jugular veins and techniques for estimating CVP, as well as ways in which abnormal findings may be interpreted.