Difficult central line placement due to variant internal jugular vein anatomy.

The internal jugular vein (IJV) is an optimal location for obtaining central venous access due to its superficial location. However, there are many potential pitfalls of using the landmark technique, including aberrant anatomy of the IJV, proximity to the carotid artery and cupola of the lung, body habitus, and prior neck surgery. Our case study demonstrates how the use of ultrasound greatly simplified cannulation of an aberrant IJV in a dialysis patient.