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.