How To Use The Internal Jugulars As A Manometer

1. What reference level is used as zero?

ANS: The sternal angle (angle of Louis).

2. What are the upper limits of normal for jugular pulsation in the (a) supine and (b) 45° position with the sternal angle as zero?

ANS: a. The supine upper limit is 2 cm.

Venous pressure can be estimated by observing the upper level of internal jugular pulsations above the sternal angle. If it is over 4.5 cm at 45°, it indicates an

Venous pressure can be estimated by observing the upper level of internal jugular pulsations above the sternal angle. If it is over 4.5 cm at 45°, it indicates an b. The 45° upper limit is 4.5 cm. (It is easy to remember 4.5 cm at 45°.)

3. Why is it important to know the venous pressure at 45° rather than supine? ANS: Supine, the top level of a normal venous pressure may not be seen because it could be above the angle of the jaw at mid-face level.

The 2-cm level is above the angle of the jaw in this patient. Therefore, only if her top level of pulsations were lower down at sternal-angle level would the upper level be measurable. At 45°, her top level ofjugular pulsations was below jaw level and was measurable.

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