Preventing vascular damage during central venous catheter insertion via the internal jugular vein

Central venous catheters (CVCs) are utilised widely in the critical care environment, however their utilisation is not without risk. Significant morbidity and mortality can result from complications relating to their insertion, creating a healthcare burden in patient quality of life, hospital days and cost. Internationally, closed claim data suggest that the majority of mechanical complications associated with CVCs are vascular injuries, and most often, preventable. Relevant injuries include arterial injury, venous injury, and subsequent bleeding and haematoma. Safe vascular access is integral to anaesthetic and critical care practice, and the diligent application of evidence-based prevention measures aims to reduce future morbidity. Strategies to prevent, recognise and manage vascular complications in reference to internal jugular vein (IJV) catheterisation will be discussed.