Internal Jugular Vein Approaches
Points of possible catheterization: ANTERIOR CENTRAL POSTERIOR SUPRACLAVICULAR Traditional and safe approach is CENTRAL (pay attention to the direction of the needle): The patient is placed in the Trendelenburg position with his or her head turned to the contralateral side. The physician stands above the patient on the contralateral side of the bed, and a large skin wheal is raised with local anesthetic over the junction of the sternal and clavicular divisions of the sternocleidomastoid muscle. While the medially located carotid artery (which courses under the sternal division) is palpated, a 11/2 inch, 22-gauge needle and syringe are used to locate the internal jugular vein which lies lateral to the carotid artery, immediately beneath the medial border of the clavicular division. The needle should enter the skin at a 30 to 45 angle directed laterally toward the midclavicle, thereby avoiding possible puncture of the c...