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. 2011:4:27-39.
doi: 10.2147/RMHP.S10383. Epub 2011 Apr 13.

Anatomic considerations for central venous cannulation

Michael P Bannon  1 , Stephanie F Heller, Mariela Rivera
Affiliations

Anatomic considerations for central venous cannulation

Michael P Bannon et al. Risk Manag Healthc Policy. 2011.

Abstract

Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed.

Keywords: Internal jugular vein; cannulation; ultrasound; venipuncture.

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Figures

Figure 1
Figure 1
Long-term right internal jugular venous catheter (tip at orange arrow) appropriately positioned relative to right tracheobronchial angle (at yellow arrow).
Figure 2
Figure 2
Computed tomography scan showing venous course from right internal jugular vein (blue arrows) and venous course from left subclavian vein (yellow arrow) through the innominate vein (white arrow) to superior vena cava (orange arrow); course from left internal jugular vein (green arrow) with turns at junctions with innominate vein and superior vena cava.
Figure 3
Figure 3
Computed tomography scan showing right angle junction (arrow) of right subclavian vein with superior vena cava.
Figure 4
Figure 4
Ultrasound probe prepared within sterile sheath.
Figure 5
Figure 5
Sedillot’s triangle: sternal head of sternocleidomastoid (yellow arrow), clavicular head sternocleidomastoid (orange arrow), clavicle (red arrow); and position of appropriate cutaneous puncture at apex of triangle (black star).
Figure 6
Figure 6
External jugular vein crossing the posterior border of sternocleidomastoid (arrow), Sedillot’s triangle (red star), and sternal notch (black star).
Figure 7
Figure 7
Ultrasound image of right carotid artery (yellow star) and right internal jugular vein (white star).
Figure 8
Figure 8
Ultrasound image of right internal jugular vein compressed by gentle probe pressure (white star) and carotid artery (yellow star).
Figure 9
Figure 9
The “break” of the clavicle (arrow) and position of appropriate cutaneous puncture (black star). Note that head and neck drapes must always be placed with care to avoid potential airway obstruction and to allow appropriate airway assessment.
Figure 10
Figure 10
Computed tomography scan demonstrating apposition of right subclavian vein to pleura (arrows).
Figure 11
Figure 11
Computed tomography scan demonstrating apposition of left subclavian vein to pleura (arrows).
See this image and copyright information in PMC

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