Anatomical considerations of the anterior approach for central venous catheter placement

Abstract

Central venous catheterization (CVC) entails the catheterization of the superior vena cava via either the subclavian or the internal jugular vein (IJV). This study looked at the frequency in which a needle was inserted into the IJV using the anterior CVC approach, which entails inserting the needle into the apex of Sedillot's triangle, formed by the sternal and clavicular heads of sternocleidomastoid (SCM). The ipsilateral distances from the apex of Sedillot's triangle to the superior aspect of the sternoclavicular joint and the diameter of the IJV were also measured. A needle was inserted into the apex of Sedillot's triangle in 36 adult cadavers with mean age of 62 +/- 19 years (mean +/- SD), mean height of 1.6 +/- 0.18 m, and a mean weight of 55 +/- 16 kg. Subsequent dissections of this area revealed the relation of the needle to the IJV. Results indicate that on the right, the needle was inserted into the IJV in 97.14% of the cases. On the left, the needle entered the IJV in 78.79% of the cases. From the sternoclavicular joint, the apex of Sedillot's triangle was found to be 40.87 +/- 1.62 mm and 38.73 +/- 6.34 mm on the right and left, respectively. The IJV diameter was 17.29 +/- 1.07 mm on the right and 15.30 +/- 0.25 mm on the left. We conclude that the anterior CVC approach is an anatomically accurate technique. It is furthermore important to realize that when performing any invasive procedure, a sound anatomical knowledge of the region is extremely important, as complications are often due to lack of understanding or misunderstanding of the relevant anatomy.

Topographical anatomy of central venous system in extremely low‐birth weight neonates less than 1000 grams and the effect of central venous catheter placement

“…The reason for this observation remains unclear. In adults (Botha et al,2006) and young children, it was shown that there was no significant difference in the diameter between the internal jugular and subclavian venous system (Loeweneck et al,1978; Cobb et al,1987), in contrast to our findings, where the internal jugular veins are larger than the subclavian veins. The reason for this may lie in the different head to body ratio during child development.…”

Multiple Variations of the Superficial Jugular Veins: Case Report and Clinical Relevance

“…The veins of the neck are expanded as two separate venous systems, the superficial or subcutaneous comprised the anterior and external jugular veins draining mostly the subcutaneous tissues and the deep veins comprised the internal jugular veins draining mainly the brain and other structures of face and neck (27). The internal as well as the external jugular veins represent two of the most common routes for the insertion of central venous catheters via percutaneous approach (6,22). Also, correct placement of central venous catheters may be possible via the anterior jugular venous system (22).…”

Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

“…Some studies have demonstrated that certain demographic factors or multiple percutaneous punctures per procedure have been associated with CVC complications [21]. In terms of site of introduction, multiple studies have shown that the right internal jugular vein approach is associated with lower rates of mechanical complications relative to other sites, which may be partially attributable to differences in diameter between each vein [22][23][24]. Within our study, we also found that catheter insertion from the right side was associated with a greater likelihood of maintained patency [25].…”