Discrimination of the JVP from the carotid pulse

The JVP can be discriminated from the carotid pulse because:

• it cannot be palpated
  
  
• it has a complex wave form; it is usually seen to flicker twice within each cardiac cycle
  
  
• it moves on respiration, normally decreasing on inspiration and rising on expiration; for exceptions, see Kussmaul's sign
  
  
• mild pressure applied to the base of the neck overlying the proximal part of the internal jugular vein will break the column of blood in it, and obliterate its pulsations
  
  
• mild pressure applied over the liver will expel more blood into the right side of the heart and elevate the JVP, a positive hepato-jugular reflex