Ultrasound JVP: find the collapse point

Answer d. Below the top of the column, blood fills and distends the vein. Above it, the vein is empty and its walls meet. The collapse point is the ultrasound equivalent of the top of the visible pulsation in a clinical JVP. Width of the vein varies with position, probe pressure and breathing.

Answer d. The internal jugular vein is a low-pressure vessel. Even modest probe pressure closes it, which makes the column look shorter than it is. Rest the probe on the gel with almost no pressure before you judge the collapse point.

Answer c. When the vein stays filled high into the neck, the column of blood above the right atrium is tall. This suggests raised right atrial pressure, as in a raised JVP on examination. Combine it with the heart, lungs and history before you act.

Answer a. The right internal jugular vein runs almost straight down through the brachiocephalic vein and superior vena cava into the right atrium. The left takes a longer path across the chest, where other structures compress it. This is the same reason a clinical JVP is examined on the right.

Answer b. Positive-pressure ventilation raises pressure in the chest and fills the neck veins, so the collapse point no longer reflects right atrial pressure alone. Forceful breathing, severe tricuspid regurgitation and superior vena cava obstruction mislead in the same way. The other options are the standard technique.