Percutaneous catheterisation of the internal jugular vein

Abstract

This paper describes the results of 500 percutaneous catheterisations of the internal jugular vein. The first 200 of these have been previously reported 1.Several techniques of central venous catheterisation for pressure recording or mixed venous sampling have been developed previously. The complications of infraclavicular subclavian venepuncture have been described by several authors, the commonest being pneumothorax. Damage to the subclavian vein, extravenous placement of the catheter in the tissues or pleural cavity and septicaemia have also occurred*-5. A supraclavicular technique has been described with a low incidence of complications 6 although we have as yet no experience with this method. Percutaneous femoral vein catheterisation has also been described but has a high (46 %) complication rate including four fatalities from septicaemia'. The insertion of a long catheter from the antecubital fossa either by cutdown or venepuncture quite often results in thrombophlebitis and it is frequently difficult to thread the catheter into the central veins. External jugular venous anatomy is inconstant and it is difficult to thread a catheter past the valve commonly present at its termination5.The value of central venous pressure monitoring is unquestioned and as it is frequently necessary in cardiac surgery we have developed two techniques for catheterising the internal jugular vein by percutaneous venepuncture. A N A T O M YThe internal jugular vein emerges from the base of the skull posterior to the internal carotid artery. It terminates at the inner border of the anterior end of the first rib behind the clavicle. During its course through the neck it becomes lateral and then antero-lateral to the carotid arteries and is covered superficially for most of its length by the sternomastoid muscle. The posterior belly of the digastric muscle, the omohyoid muscle and the vessels and nerves to sternomastoid cross the vein superficially. When the head is turned to the opposite side the internal jugular vein in the lower part I

Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn

“…The internal jugular vein (IJV) provides a predictable path for central venous cannulation, but in children, a failed attempt of catheterization of the RIJV guided by anatomical references is inversely proportional to age, and it occurs in up to 60% of infants less than 3 months of age compared with adult patient populations (16%) [8][9][10].…”

The Accuracy of the Central Landmark Used for Central Venous Catheterization of the Internal Jugular Vein

“…The "central" landmark, first described by English et al (10,11) is commonly used. This approach includes turning the head away from the side to be catheterized, defining the apex of the triangle formed by the 2 heads of the sternocleidomastoid muscle as the sides of a triangle and the clavicle as the base, (12) and inserting a needle at approximately 30 -45 degrees to the coronal plane at this apex, aiming towards the ipsilateral nipple.…”

Malposition of central venous catheter

“…For cannulating the subclavian veins, the infraclavicular approach at the midclavicular point with the patient's head turned away from the side of the puncture as described by Wilson et al 5 …”