1. Position the patient supine with the head of the table elevated 45 degrees.
    
2. Use tangential, side lighting to observe for venous pulsations in the neck.
    
3. Look for a rapid, double (sometimes triple) wave with each heart beat.
   Use light pressure just above the sternal end of the clavicle to eliminate the pulsations and rule out a carotid origin.
    
4. Adjust the angle of table elevation to bring out the venous pulsation.
    
5. Identify the highest point of pulsation.
   Using a horizontal line from this point, measure vertically from the sternal angle. The sternal angle is about 5 cm above the right atrium
    
6. This measurement should be less than 4 cm in a normal healthy adult

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