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.

Patient 1:

This patient was admitted to the hospital with decompensated heart failure. She provides an example of a visible external jugular vein that can be used to estimate central venous pressure. The vessel itself is visible in the neck. There is a nearby arterial pulse that provides for an outstanding comparison between arterial and venous waveforms. The astute observer will notice that there is one dominant descent in the jugular venous waveform in this video, and it is occurring at the same time as the arterial pulse, indicating that it is the x rather than the y descent.

Patient 2:

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

Patient 3:

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

Patient 4:

This is a middle-aged man with a history of mediastinal lymphoma treated with mantle-field radiation complicated by superior vena cava stenosis and thrombosis, resulting in superior vena cava syndrome.