ABSTRACT
At end expiration, the venous pulsations of the right internal jugular vein provide a direct measure of right atrial filling pressure when the patient is relaxed and the head and chest are elevated to 45 degrees. If these pulsations are not seen, the elevation of the bed can be lowered and a light can be pointed tangentially across the neck to help visualize them. The vertical distance measured from the venous pulsations to the sternal angle of Louis with the addition of 5 cm (the approximate distance of the right atrium below the angle of Louis) is a rough estimate of the right atrial pressure. Normal right atrial pressures are 2-10 mmHg. A hepatojugular reflex may indicate elevated central venous pressure and volume overload. Gentle pressure is applied over the liver with the patient semirecumbent (45 degrees). The jugular vein area is inspected to determine if the vein fills during liver compression.
