Jugular Venous Pulse via External Jugular Vein

When the right and left internal jugular veins fail to provide adequate evaluation of the jugular venous pulse, the external jugular vein can be used to estimate central venous pressure. The external jugular is easily recognizable as a visible vein on the surface of the neck (much like the veins on the dorsum of the hand can be visualized). Unlike the internal jugular vein, which provides indirect evaluation of the jugular venous pulse via movement of the overlying skin (the actual vessel itself is not visualized), the external jugular vein provides direct evaluation of the jugular venous pulse. However, the external jugulars often transmit the venous waveform poorly. These veins are therefore suitable for quantitative assessment of the jugular venous pulse, but are not reliable for qualitative assessment.

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Patient 3

This is a middle-aged woman with decompensated heart failure.