To visualize the jugular wave forms, the patient should lie flat without a pillow so that his or her neck is not flexed and does not interfere with the pulsations. The patient's trunk should be at approximately 25° to the horizontal. The higher the venous pressure is, the greater the elevation that is required;the lower the pressure, the lower the elevation needed. The patient's head should be turned slightly to the right and slightly down to relax the right sternocleidomastoid muscle. Standing on the patient's right side, the examiner should place his or her right hand, holding a small pocket flashlight, on the patient's sternum and shine the light tangentially across the right side of the patient's neck. Shadows of the pulsations will be cast on the sheet behind the patient. The light and shadows magnify the wave forms. This technique is demonstrated in Figure 14-25. If no wave forms are seen, the angle of elevation of the head of the bed should be reduced. To help identify the wave forms, the examiner can time the cardiac cycle by palpating the cardiac impulse beneath his or her right hand or by feeling the left carotid impulse with his or her left hand. The descents, rather than the waves themselves, tend to be more obvious. If the neck veins are visible at the jaw margin while the patient is seated, the examiner should watch for the wave forms at the angle of the jaw with the patient seated upright.
The jugular pulse must be differentiated from the pulsation of the carotid artery. Table 14-6 lists the most important characteristic differences of these pulses.
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