Safe Placement of Central Venous Catheter Into Internal Jugular Veins

Abstract

Performance of bilateral nephrectomy and renal transplantation created the need of a new site for safe percutaneous placement of the central venous catheter. The internal jugular veins, especially the left, were safely entered by an anterior approach at least 2 inches above the clavicle in well over 100 critically ill patients. The surgeon stands at the head of the bed and uses his index and middle fingers to separate the common carotid artery and the sternocleidomastoid muscle. The needle is inserted between these structures and usually enters the vein on the first passage behind the muscle if the shaft is held in the parietal plane of the body at a posterior angle of 30°.