The following section will outline the key steps in performing ultrasound-guided central venous catheterization of the internal jugular vein. This section will conclude with a video tutorial.
Steps in central venous cannulation
Prior to setting up and prepping the skin, ensure the internal jugular vein is clearly visible and the anatomy is clear for venous access (ex. the IJ does not directly overlap the carotid artery). Many beginners will turn the head to the contra-lateral side, which may lead to significant anatomical distortion.
Orientation and compression
Double check orientation of the probe to ensure proper anatomic alignment. The screen marker on the left in this clip aligns with the patient’s left. Compression also ensure the vein is free of thrombus.
Anesthetize the skin
Ultrasound can be used to plan the site of cannulation and help guide infiltration of local anaesthesia in the superficial tissues.
Short vs long axis
In this clip, we can see the short vs long axis approach for venous cannulation. While either can be used, the long axis plane can be more technically challenging to the novice or even intermediate practitioner. The more common approach, particularly for those learning, is the short axis approach.
Be aware that your short-axis plane must be constantly shuffling between advance of the needle tip and at the needle tip to prevent confusion in imaging the needle shaft. Make sure to visualize the needle tip in short axis at a shallow depth and track slowly as you enter (“Creep technique”). The video clip demonstrates that two probes (both are probes are end-on) may come to the same conclusion, despite the fact they are capturing two different areas. Always be at the distal tip of the needle. Carefully insert the needle until a venous flash.
Confrim wire placement
After successful venous cannulation and insertion of the wire, it should be visualized in two planes along its anatomical course. While this practice does not have a robust evidence base, it is evident that unequivocal intra-vascular visualization is reassuring prior to dilatation and final catheter insertion.
This video tutorial delves further into the practical use of ultrasound to guide venous cannulation. While ultrasound offers much benefit, technical mastery can optimize safety and increase the chance of successful placement.
This video tutorial uses advanced stereoscopic recording technology to deliver an immersive ultrasound training experience. Click on the button to view in YouTube in true VR.