title: Accuracy of Anatomical Landmarks in Locating the Internal Jugular Vein Cannulation Site among Different Levels of Anesthesia Trainees.
abstract: BACKGROUND
  Internal jugular vein (IJV) cannulation is a common practice procedure employed by anesthesiologists to access large central veins. The purpose of this study is to examine the accuracy of the use of superficial anatomical landmarks to locate the IJV as well as to delineate differences in accuracy at various levels of anesthesiology trainees, and staff.
  
  
  METHODS
  We prospectively evaluated the accuracy of locating the left and right IJV on the skin surface by anesthesiology residents and board certified anesthesiologists. Twenty-four patients with body mass index (BMI) <30 and 24 morbidly obese patients with BMI > 40 were employed across all groups. Ultrasound imaging of the actual IJV course was utilized as a reference.
  
  
  RESULTS
  Experienced operators (Third year residents and faculty) achieved better accuracy in locating the IJV compared to first and second year residents. Higher accuracy was achieved when the carotid pulse was used as a landmark compared to the sternocleidomastoid muscle, particularly for experienced operators in morbidly obese patients. Overall, there was no difference in accuracy between the right and left IJV, although medial deviation was greater on the left side.
  
  
  CONCLUSIONS
  The accuracy of locating the IJV on the skin surface improved with operator experience in our anesthesiology training program. Experienced operators improved their accuracy using the carotid pulse as the external landmark. Ultrasound may be a useful tool to improve IJV localization early during training, and for cannulation of the left IJV.
authors.affiliation: Anesthesiologist, Veterans Affairs Medical Center St. Louis, MO.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Helwani
authors.affiliation: Associate Professor of Anesthesia, Department of Anesthesiology Creighton University School of Medicine Omaha, NE.
authors.forename: Nahel
authors.initials: N
authors.lastname: Saied
authors.affiliation: Professor of Anesthesia, St. Louis University School of Medicine St. Louis, MO.
authors.forename: Shigemasa
authors.initials: S
authors.lastname: Ikeda