Neutral head position for placement of internal jugular vein catheters.

A new approach to the internal jugular vein is described which keeps the head and neck in the neutral position and uses bony and cartilaginous landmarks for guidelines. Venous puncture is made along an axial line drawn superiorly from the lateral edge of the bony depression caused by the insertion of the sternocleidomastoid muscle on the superior edge of the clavicle. This line, at the level of the cricoid cartilage, lies directly over the internal jugular vein. In 55 patients initially studied, the mean (SEM) number of puncture attempts to locate the vein was 1.4 (0.2) per patient, with an overall success rate of 98%. In 84%, the internal jugular vein was located exactly where predicted, the others were just lateral to the point. The complication rate (all short-term) was 3.6%. Subsequently the internal jugular vein was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability. An average of 1.2 (0.2) (range 1-3) attempts were made per patient to locate the vein and there were no complications. We propose this technique as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma.