The two main objectives of the examination of the neck
veins are inspection of their waveform and estimation
of the central venous pressure. There is no controversy
regarding the clinical method of examination of waveform
of jugular venous pulse. However there are limitations
of clinical assessment of central venous pressure by
jugular vein pressure measurement from the level of
sternal angle. In these backgrounds, making venous
pressure assessment by non-invasive methods more
reliable and convenient will be quite useful. In patients
with visible JVP at the neck, measurement of central
venous pressure can be done more accurately and quite
easily from the anterior end of fourth intercostal space.
Considering the relative variations in the distance both
below and above from the sternal angle, there is no
obvious reason why JVP should still now be continued
to measure from the sternal angle in patients with
visible jugular vein pulsations in sitting position, rather
than directly and more reliable measuring from the
anterior end of the fourth intercostal space. If jugular
vein pulsations are not seen in sitting positing, venous
pressure can be measured from the horizontal plane of
the midpoint (marked at the lateral chest wall in erect
position) of the anteroposterior line from the fourth
intercostal space to back, particularly with the help of
VP manometer. Similarly upper limb venous pressure
measurements with the help of VP manometer can
make such measurements convenient and common
in health care settings, as the measurements could
be made routinely by the nurses and paramedics as
well. There is, thus, need of studies in these areas of
measuring venous pressure noninvasively to make it
more standard and convenient