critical care medicine
How To Do Internal Jugular Vein Cannulation, Ultrasound Guided
Equipment for Internal Jugular Vein Cannulation, US Guided
Antiseptic solution (eg,chlorhexidine-alcohol,chlorhexidine, povidone iodine, alcohol) Large sterile drapes, towels Sterile head caps, masks, gowns, gloves Face shields Ultrasound machine with a high-frequency (eg, 5 to 10 MHz), linear array probe (transducer) Ultrasound gel, nonsterile and sterile Sterile probe cover to ensheathe probe and probe cord, sterile rubber bands (alternatively, the probe may be placed within a sterile glove and the cord wrapped within a sterile drape) Cardiac monitor Local anesthetic (eg, 1%lidocainewithoutepinephrine, about 5 mL) Small anesthetic needle (eg, 25 to 27 gauge, about 1 inch [3 cm] long) Large anesthetic/finder* needle (22 gauge, about 1.5 inches [4 cm] long) Introducer needle (eg, thin-walled, 18 or 16 gauge, with internally beveled hub, about 2.5 inches [6 cm] long) 3- and 5-mL syringes (use slip-tip syringes for the finder and introducer needles) Guidewire, J-tipped Scalpel (#11 blade) Dilator Central venous catheter (adult: 8 French or larger, minimum length for internal jugular catheter is 15 cm for right side, 20 cm for left side) Sterile gauze (eg, 4 × 4 inch [10 × 10 cm] squares) Sterile saline for flushing catheter port or ports Nonabsorbable nylon or silk suture (eg, 3-0 or 4-0) Chlorhexidinepatch, transparent occlusive dressing * A finder needle is a thinner needle used for locating the vein before inserting the introducer needle. It is usually not needed for ultrasound-guided cannulations. The external diameter of the CVC should be less than or equal to one third of the internal diameter of the vein (as measured by ultrasound) to reduce the risk of thrombosis. Having an assistant or two is helpful. 