Examination of the jugular venous pulse

Estimation of jugular venous pressure is performed with the patient supine with the head of the bed elevated 30 degrees and head turned slightly to the left. A card is placed horizontally at the top of the oscillation point of the right internal jugular venous pulsation just posterior to the sternocleidomastoid muscle. The vertical height of the card above the sternal angle is measured in centimeters (cm). In this patient, the height is about 2 cm. Venous pressure is elevated above normal when it is >3 to 4 cm above the sternal angle with the head of bed elevated to 30 degrees or approximately 8 to 9 cm in total distance above the right atrium.