A puncture of the internal jugular vein (Fig. 8.165) carries fewer risks, but local hematoma and damage to the carotid artery are again important complications.
Current practice is to identify major vessels using ultrasound and to obtain central venous access under direct vision to avoid any significant complication.
In the clinic
The jugular venous pulse is an important clinical sign that enables the physician to assess the venous pressure and waveform and is a reflection of the functioning of the right side of the heart.