Internal Jugular Line Course - cont'd info

Indications for internal jugular venous catheter placement

  • No peripheral access?
  • Emergency venous access
  • CVP/ScVO2 monitoring
  • Central Parenteral Nutrition 
  • Hemodialysis access 
  • Infusion of medications
  • Access for pulmonary artery catheter or transvenous pacemaker

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Contraindications for internal jugular venous catheter placement

  • Patient refusal
  • Deep venous thrombosis of vein
  • Overlying burn or cellulitis
  • Thrombocytopenia with platelets <20,000
  • Anticoagulation is a relative contraindication for accessing a compressible vein 
  • Inability to lie flat 


Complications of internal jugular venous catheter placement

  • Central line-associated Bloodstream Infection (CLABSI) (femoral>IJ>subclavian)
  • Deep venous thrombosis (femoral > IJ = subclavian)
  • Pneumothorax (subclavian > IJ)
  • Hemothorax (subclavian > IJ)
  • Hematoma (femoral > subclavian = IJ)
  • Arterial injury or arterial cannulation (femoral > IJ > subclavian)
  • Bleeding (femoral > IJ > subclavian)
  • Air embolus (IJ = subclavian)
  • Dysrhythmias (IJ > subclavian)
  • Lost guidewire 

Equipment for internal jugular venous catheter placement

  • Cap
  • Mask
  • Sterile gown
  • Sterile gloves
  • Central line kit
  • Biopatch (if available)
  • Sterile occlusive dressing
  • Sterile saline flushes
  • Needleless caps
  • Point of care ultrasound with linear array probe
  • Sterile ultrasound sheath with sterile ultrasound gel and sterile rubber bands

Proper positioning and technique for internal jugular venous catheter placement

    • Trendelenberg position
  • Turn neck slightly in contralateral direction
  • Prep skin with chlorhexidine swab and allow at least 2 minutes to dry
  • Wide sterile drape
  • Apply sterile sheath over linear array probe
  • Identify ideal insertion site with ultrasound probe
  • Anesthetize skin and underlying soft tissue
  • Advance introducer needle under real-time ultrasound guidance to cannulate IJ vein
  • Stabilize needle hub and remove syringe
  • Quickly advance wire about 20 cm through needle
  • Remove needle leaving wire in place
  • Use scalpel to nick skin
  • Use dilator over wire to dilate subcutaneous tract
  • Advance catheter over wire to appropriate depth of insertion
  • Remove wire leaving catheter in place
  • Flush all catheter ports with sterile saline
  • Secure catheter in place with suture
  • Apply biopatch at insertion site if available
  • Apply sterile occlusive dressing
  • CXR to confirm catheter tip placement


Coding for internal jugular venous catheter placement

 36556 – central venous catheter insertion

76937 – ultrasound guidance for vascular access