We shall now evaluate our patient’s venous pulse in two categories: the venous pressure and the wave form. Let’s begin with the venous pressure. The sternal angle is 5 cm higher than the mid right atrium. We identify the venous wave form on the inferolateral aspect of the sternocleidomastoid. It is pulsating about 1 cm lower than the sternal angle, therefore, this is a patient who has about a 4 cm central venous pressure and it is normal.

Now let’s look more carefully at that wave form. We will time the wave form with the carotid vessel, using the cotton swab and we can clearly see that slightly larger “a” wave, normal, but larger than the second wave; that “a” wave that precedes the carotid impulse, and then the “v” wave that comes just after the carotid impulse.

This is a normal central venous pressure and a normal wave form.