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ULTRASOUND-GUIDED LATERAL APPROACH TO INTERNAL JUGULAR CATHTER PLACEMENT

Contributors: Marcus Jarboe, MD

The approach to the internal jugular vein is started adjacent to the clavicle, just lateral to the sternocleidomastoid muscle on the the right side. The ultrasound probe is placed in a transverse fashion cephalad and adjacent to the clavicle. The needle trajectory is in-line with the probe. The lateral approach enables clear and simultaneous visualization of the entire needle and key anatomic structures such as the edge of the lung, the internal jugular vein, and the carotid artery. Second, the approach allows a gentle curve on the catheter when tunneling, avoiding kinks and avoiding tendency of catheter movement in the tunnel pocket when the neck moves. Third, in cases of internal jugular occlusion, the lateral approach makes it possible to access the brachiocephalic vein.

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Average Rating: 5.0 out of 5 (1 votes)
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Robert Molyneaux
American Pediatric Surgical Association

Transverse Lateral IJ approach

Excellent demonstration of the potential increased safety of the lateral approach. Note: this approach also work for non-tunneled catheters. Securing the non-tunneled CVC hub to the clavicle creates a more comfortable, easier to maintain and dress CVC with the same gentle curve as the tunneled route. The dressing also sheds oral and nasal secretions better than securing to the neck in critically ill patients with this technique.

6 months ago

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