critical care medicine
How To Do Internal Jugular Vein Cannulation
Tips and Tricks for Internal Jugular Vein Cannulation
A thin (finder, scout) needle often is used to first find the internal jugular vein (before inserting the larger introducer needle) so that less bleeding and hematoma result if the needle aberrantly impales the carotid artery. (Ultrasound guidance eliminates the need for a finder needle.) The orientation of the carotid artery and internal jugular vein to each other may change if the position of the patient’s head changes; thus, to avoid impaling the artery, you should gently palpate the carotid pulse during the needle insertions included in this procedure. The size of the internal jugular vein varies with respiration (maximum diameter in patients not intubated occurs just prior to inspiration [prior to expiration in intubated patients]) and is increased by the Trendelenburg position, the Valsalva maneuver, humming, and external abdominal compression. To increase your chance of successful internal jugular cannulation, advance the introducer at moments of increased jugular diameter. 