Assessment of the jugular venous pressure is often inadequately performed and undervalued. Here, we review the physiologic and anatomic basis for the jugular venous pressure, including the discrepancy between right atrial and central venous pressures. We also describe the correct method of evaluating this clinical finding and review the clinical relevance of the jugular venous pressure, especially its value in assessing the severity and response to treatment of congestive heart failure. Waveforms reflective of specific conditions are also discussed.

Percutaneous entry of the brachial artery using a sheath system has been attempted in 223 patients undergoing left heart catheterization; successfully, in 212. After arterial puncture, a dilator and sheath are passed over a short guidewire. A number 7-80 cm Sones specially stiffened coronary catheter is passed through the sheath, and left heart catheterization is performed in the usual manner. The study can usually be completed with this single catheter. Initial entry, as well as any needed catheter change, is facilitated by the use of an inflatable sphygmomanometer cuff around the upper arm. Ease of manipulation and patient comfort have been satisfactory, and brachial artery spasm has not been encountered. There have been no major complications and a low incidence (approximately 15%) of brachial arterial occlusion.

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