Internal Jugular Line Course

An internal jugular line placement may need to be performed for a variety of medical conditions, or emergency procedures.  This can be a technically challenging procedure and in some cases the patient may be very ill or significantly injured.

Due to the jugular vein’s position adjacent to the carotid artery and several adjacent muscles, the internal jugular line placement must be performed with careful precision.  Complications arising from the procedure can result in carotid artery damage, haematoma, and pneumothorax in some rare cases, death.  As a result of the potential for serious damage to surrounding arteries and muscles, ultrasound is often used to assist in the placement of the internal jugular line.

In general, ultrasound guidance is preferred over the landmark-based technique.  Ultrasound guidance has increased internal jugular line placement success rates to over 90%.    Compilications arising from the procedure decreased by 57% when using ultrasound to locate the jugular vein as opposed to the landmark-based technique.  The most obvious reasons for the preference for ultrasound assisted IJ line placement included a higher success rate overall, higher first attempt success, shorter access time, lower chance of carotid artery puncture, and lower chance of hematoma.

Using the ultrasound based technique, imaging provides the hospitalist or emergency physician with the location of the jugular vein.  The landmark-based technique involves a physician or other qualified personnel determining the location of the jugular and best entry position according to its position relative to adjacent muscles, tissue, and arteries.

Internal placement has several proven benefits when compared to the peripheral IV placement.  The internal jugular approach is preferred when possible due to the vein’s significant rate of blood flow,  substantial size, relatively straight orientation, and small mal position rate.  The most obvious drawback to the internal jugular vein is its location near the carotid artery.  The internal jugular vein is the most typical choice for central access by anesthesiologists.

Internal jugular line placement has numerous applications for a variety of medical procedures.  If you have a question that isn’t answered on this page, or if you’re just interested in discussing the procedure in greater detail, then we encourage you to contact an HPC physician directly at www.Facebook.com/HospitalProcedures.  It is our goal to provide an expert online resource for your hospital procedures and emergency medicine queries.  We look forward to discussing!