Placement of jugular venous catheters
- Mark P Androes, MD
Mark P Androes, MD
- Assistant Professor of Surgery
- University of South Carolina School of Medicine
- Alan C Heffner, MD
Alan C Heffner, MD
- Director of Critical Care
- Director of ECMO Services
- Pulmonary and Critical Care Consultants
- Department of Internal Medicine
- Department of Emergency Medicine
- Carolinas Medical Center
- Associate Clinical Professor
- University of North Carolina School of Medicine
- Section Editors
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
Central catheters provide dependable intravenous access and enable hemodynamic monitoring and blood sampling [1-3]. The jugular veins are one of the most popular sites for central venous access due to accessibility and overall low complication rates, and are the preferred site for temporary hemodialysis.
Jugular venous cannulation and catheter placement will be reviewed here. General considerations for venous access and issues related to other access sites are discussed elsewhere. (See "Overview of central venous access" and "Complications of central venous catheters and their prevention" and "Placement of femoral venous catheters" and "Placement of subclavian venous catheters".)
The jugular veins (internal, external) are reliable access sites for temporary and permanent (table 1) (eg, tunneled central catheters and subcutaneous ports) venous cannulation to support hemodynamic monitoring, fluid and medication administration, and parenteral nutrition. Jugular venous access can also be used for the placement of inferior vena cava filters and other venous devices. (See "Placement of vena cava filters and their complications".)
Internal jugular venous access (especially right-sided) is associated with a low rate of catheter malposition , and is commonly used in situations that require reliable tip positioning for immediate use, such as drug administration or transvenous pacing. Similarly, the direct route from the right internal jugular vein to the superior vena cava facilitates hemodialysis access and pulmonary artery catheter placement. (See "Central catheters for acute and chronic hemodialysis access" and "Pulmonary artery catheters: Insertion technique in adults".)
Contraindications — Relative contraindications to jugular venous catheterization, in general, include coagulopathy, prior access, the presence of another device at the site, and altered local anatomy. (See "Overview of central venous access", section on 'Contraindications'.)
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- JUGULAR VEIN ANATOMY
- JUGULAR SITE SELECTION
- Static ultrasound guidance for vein localization
- GENERAL PREPARATION
- Skin preparation
- INTERNAL JUGULAR VEIN CANNULATION
- Needle access
- - General techniques
- Access with introducer needle
- Using a seeker needle
- Using an angiocatheter
- - Approaches to the internal jugular vein
- - Dynamic ultrasound-guided internal jugular access
- Venous confirmation
- CATHETER PLACEMENT
- Guidewire handling
- Tract dilation
- Positioning the catheter
- Catheter flushing and fixation
- CONFIRMATION OF JUGULAR CATHETER POSITION
- CATHETER MANAGEMENT
- SUMMARY AND RECOMMENDATIONS