Author + information
- Donald M. Rocklin, MD∗ ( )()
- ↵∗Yale Heart and Vascular Center, Yale Medical School, 2 Devine Street, North Haven, Connecticut 06473
I enjoyed the recent article by Thibodeau and Drazner (1) about the physical examination in heart failure.
There are 9 excellent tips given for assessing central venous pressure (CVP).
I would like to add 2 more that are really quick and easy, and better suited for those who are less skilled or patient with the usual techniques.
The first is called the “fill and fall technique.”
The edge of the hand, with fingers extended, is used to moderately compress the base of the neck just above the clavicle. The external jugular veins (including the lateral and sometimes anterior ones) become distended and readily visible. Then, when the hand is released, the external jugular veins will fall, if the CVP is normal or low. Voila! (Figures 1 and 2⇓⇓).
The second technique is to have the patient do a Valsalva maneuver. This often fills up the internal and external jugular veins.
Precautions should be taken in those with large fleshy necks where nothing is visible and those with already distended veins—strap muscles, venous occlusion or high CVP. Then, the vein is compressed from above, then below, and then “milked” to see the direction from which it fills; the other excellent techniques in the article can then be used. Distended hand veins can also be raised above the level of the heart and fall to grossly estimate venous pressure.
Please note: Dr. Rocklin has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation