title: Sonographic guidance when using the right internal jugular vein for central vein access.
abstract: OBJECTIVE
  The intent of this study was to substantiate the advantages of the use of sonographic guidance for central venous access via the right internal jugular vein.
  
  
  METHODS
  Eighty sequential patients requiring central vein access were examined with a hand-held sonography transducer to determine the size, patency, and location of the right internal jugular vein before puncture. Access to the right internal jugular vein was subsequently performed, under sterile conditions, using sonographic guidance. Periprocedural complications were prospectively recorded. Subsequently, we compared our findings with published reports of complications when visible and palpable anatomic landmarks were used for guidance during cannulation of the internal jugular vein.
  
  
  RESULTS
  Among these 80 patients, the anatomy of the right internal jugular vein was typical in only 57 (71%). In another 13 patients (16%), sonography showed a medial position of the right internal jugular vein, anterior to the common carotid artery. In three other patients (4%), the right internal jugular vein was positioned laterally by more than 1 cm. In the remaining seven patients (9%), the vein was thrombosed. Its diameter, measured without use of the Valsalva maneuver, also varied, measuring 0.5-2.0 cm. Cannulation was achieved in all 73 patients with a patent right internal jugular vein. One puncture was required in 68 patients (93%); two punctures in three other patients (4%); and three punctures in the remaining two patients (3%). In no case was the common carotid artery inadvertently punctured. Only one periprocedural complication occurred, and it was unrelated to the use of sonographic guidance.
  
  
  CONCLUSIONS
  Sonographic guidance for central vein access via the right internal jugular vein is safer and more efficient than the traditional landmark approach.
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville 32610-0374, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Caridi
authors.forename: I F
authors.initials: IF
authors.lastname: Hawkins
authors.forename: B N
authors.initials: BN
authors.lastname: Wiechmann
authors.forename: D J
authors.initials: DJ
authors.lastname: Pevarski
authors.forename: J C
authors.initials: JC
authors.lastname: Tonkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional