Ultrasound-Guided Internal Jugular Vein Cannulation

overview Traditionally, internal jugular vein cannulation has been performed with the use of external anatomical landmarks and palpation to guide insertion of the needle into the vessel. However, depending on the operator’s experience and the patient’s anatomy, this procedure may be difficult or unsuccessful. Over the past decade, the increased use of ultrasonography to guide internal jugular vein cannulation has improved success rates, reduced the time required to perform the procedure, and reduced complications. 1-3 Indications Ultrasound-guided internal jugular vein cannulation is performed when direct access to the central circulation is needed. Access may be required for a variety of purposes, including monitoring central venous pressure, inserting pulmonaryartery catheters, administering intravenous therapeutic agents and nutrition, performing hemodialysis, and placing cardiac pacemakers. Contraindications General contraindications to internal jugular vein cannulation include infection of the placement site and suspected pathologic conditions affecting the internal jugular vein or the superior vena cava (such as occlusion caused by coagulopathy). Caution should be used when the landmarks have been distorted by trauma or when other anatomical anomalies are present. Be careful when using this procedure in patients who have prior injury to the internal jugular vein, have very small internal jugular veins, or are morbidly obese. In these circumstances, alternative sites should be considered; however, use of the femoral vein is associated with a higher incidence of infection and therefore should be avoided. Ultrasonography is a noninvasive, nonionizing form of imaging that is safe for use in patients of all ages and in women who are pregnant. There are no contraindications specific to the use of ultrasound guidance during internal jugular vein cannulation. Equipment Central venous catheters vary in size, length, and number of infusion ports. The choice of catheter depends on the clinical circumstance. Packaged central venous catheterization kits are commercially available. Kits may include drapes, disinfectant sponges, gauze pads, sutures with needles, a guidewire, a scalpel, a vein dilator, a penetration syringe, a guide syringe, an anesthetic syringe, and 1% or 2% lidocaine anesthetic solution. Sterile gloves, eye protection, a gown, a surgical cap, a mask, and a full-size sterile drape are also required.