Makindo Medical Notes

🩺 Introduction: Internal Jugular Vein Cannulation

• 🔑 Formal training is required before attempting. Always weigh necessity carefully, as central lines carry significant risks.
• 📄 Document justification clearly. Poor outcome predictors include: emergency placement, obesity, coagulopathy, intubation, and hypotension.
• ☎️ Involve a senior colleague if there is any doubt.

✅ Indications

• IV access (when peripheral access fails)
• Infusion of irritant substances (e.g., vasopressors, chemotherapy)
• CVP monitoring
• Advanced haemodynamic monitoring (PICCO, PA catheter)
• Central venous oxygenation monitoring
• Cardiac pacing
• Extracorporeal therapies (ECMO, CRRT)
• Other procedures: IVC filter, venous stenting, catheter-guided thrombolysis

🚫 Contraindications

• Lack of consent (or special forms if patient lacks capacity)
• Inexperienced operator without supervision
• Obstructed vein (e.g., thrombus), distorted anatomy, or severe coagulopathy
• Raised ICP or severe respiratory failure (↑ risk of pneumothorax)
• Contaminated/traumatised site, clavicle fracture, or large neck mass
• Uncooperative/agitated patient unable to lie flat

📡 Equipment and Ultrasound Guidance

• Use ultrasound guidance whenever available:
• 🫀 Artery: circular, smaller, pulsatile, non-compressible, pulsatile Doppler flow
• 🫁 Vein: elliptical, larger, compressible, dilates with Valsalva

📍 Anatomy and Technique

• IJV runs from jugular foramen → sternoclavicular joint, within carotid sheath (carotid artery + vagus nerve).
• Position: supine, 15° Trendelenburg (↑ vein filling, ↓ air embolism). Turn head away from site.
• Technique: USS-guided preferred. For landmark (Seldinger): insert needle into SCM–clavicle triangle, aim toward ipsilateral nipple.

🧵 Seldinger Technique & Catheter Positioning

• Aspirate venous blood → pass guidewire → dilator → catheter.
• Tip should lie in the superior vena cava above pericardial reflection.
• Confirm with CXR; exclude pneumothorax.

⚠️ Complications

• 🫁 Pneumothorax/haemothorax – use high approach
• 💨 Air embolism – prevent with head-down tilt
• ❤️ Arrhythmias – avoid deep guidewire insertion; ECG monitor continuously
• 🩸 Carotid artery puncture – avoid with USS; needle should remain lateral
• 🍼 Chylothorax – more common left side; avoid if possible
• 🦠 Infection – strict aseptic technique, monitor for line sepsis

🖼️ Anatomy & Technique Diagrams

📚 References

• NEJM – Internal Jugular Cannulation

💡 Clinical Pearl: Always favour ultrasound guidance for IJV cannulation. Right IJV is usually preferred (straighter path to SVC, lower risk of chylothorax). Document indication, technique, and any complications immediately post-procedure.