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Set 17, 2021

Internal jugular vein cannulation

Ultrasound-guided internal jugular vein cannulation increases the likelihood of a successful procedure and helps reduce the risk of complications.

This method of placement is therefore preferred when experienced personnel are available. Ultrasound-guided cannulation uses real-time ultrasound and a guidewire (Seldinger technique) to thread the CVC through the internal jugular vein and into the superior vena cava.

Three approaches are typically used:

  • central;
  • anterior;
  • posterior.

Below, with reference to the central one, we see what the main steps of the procedure are, the necessary equipment and some aspects to pay attention to.

Ultrasound-guided cannulation of the internal jugular vein: the steps of the procedure

Following the correct procedures for cannulation of the internal jugular vein is important to avoid the risk of complications and ensure proper placement of the central venous catheter.

First, it is important to check the function of the ultrasound machine before proceeding with the nonsterile inspection (using a short axis view) to determine whether the vein is suitable for cannulation.

Below, for macro-points, here are the steps to follow::

  • preparation of the equipment and the sterile field;
  • place the sterile cover over the ultrasound probe;
  • anesthetize the cannulation site;
  • insert the introducer needle;
  • assess the blood return;
  • insert the guidewire;
  • remove the introducer needle;
  • widen the insertion tract;
  • place the catheter;
  • dress the site.

At the end of the procedure, it is important to perform a chest x-ray to ensure that the tip of the jugular vein catheter is in the superior vena cava near its junction with the right atrium. This will also help confirm that a pneumothorax has not occurred.

Internal jugular vein cannulation: mistakes and necessary equipment

In the article "How To Do Internal Jugular Vein Cannulation, Ultrasound-Guided"1 some aspects to consider and common errors to avoid are highlighted.

For example, the tip of the central venous catheter must never lie in the right atrium, as it is thin-walled and easily perforated. A guidewire or catheter in the right atrium or ventricle may induce cardiac ectopy.

It is also important to never lose grasp of the guidewire. Other elements to watch out for are:

  • during cardiopulmonary arrest, or during low blood pressure and hypoxia, arterial blood may be dark and nonpulsatile and may be mistaken for venous blood;
  • to help prevent air embolism, CVCs should be inserted (and removed) with the vascular cannulation site positioned dependant to the heart.

Regarding equipment for internal jugular vein cannulation, sterile procedure equipment (antiseptic solutions, sterile drapes, sterile head caps, masks, gowns, gloves, face shields) are required first.

Other devices, in addition to those for ultrasound guidance, are:

  • local anesthetic;
  • needles (small/large anesthetic needle and introducer needle);
  • syringes for introducer needles;
  • guidewire;
  • scalpel;
  • dilator;
  • CVCS;
  • sterile gauze;
  • saline solution;
  • non-absorbable suture;
  • chlorhexidine patch.

In the Delta Med product range it is possible to find both central venous catheters (available in different configurations) and procedural kits that can be customized with disposable devices for diagnosis, surgery and operating room.

All products are made in Italy, designed and manufactured in our headquarters in Viadana (Mantova). To find out more, go to the dedicated page or contact us here for more information from one of our professionals.

 

Sources:

1 How To Do Internal Jugular Vein Cannulation, Ultrasound-Guided, Paula Ferrada, MD, VCU Health System

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