An obese patient presents with edema. You look for jugular venous distension and wonder if you see the ebbing in the neck (“Y descent”). Before you order BNP, there is one more thing you can do. Palpate the vein.

Large veins are palpable. In the days before we used ultrasound for central lines many of us had to learn to palpate central veins. They have thin walls and are full of fluid under low pressure, which is similar to the fluctuance of an abscess. An even better analogy would be a “water balloon” feel as you appose the walls of the vein and the edges are smooth against each other. This is sort of like those “magic eye” pictures that look scrambled but actually are three-dimensional. Some people simply can not perceive it. To those I say don’t give up, practice it, especially on yourself, and eventually you will get it.

Take Home Points:

If visualization is not obvious, palpate for jugular venous distension