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Neck anatomy: 2D ultrasound

Central line placement: Internal jugular vein

Both the National Institute of Clinical Excellence and the CDC recommended ultrasound guidance for central venous line (CVL) placement for those who have training in using the technology. Using ultrasound guidance for CVL insertion in the internal jugular vein (IJV) has been shown to reduce the risk of mechanical complications such as accidental carotid artery puncture, improve first attempt success rates, and reduce the time required for successful line placement. When ultrasound is not available or the person inserting the line is not trained in its use, landmarks and palpation of the common carotid artery (CCA) are used. When doing this it is typically assumed that the IJV is located lateral to the CCA even though in studies looking at the spatial relationship of these two vessels this is often not the case.

When using the interscalene approach for brachial plexus blockade, the ultrasound transducer is moved up and down the anterolateral surface of the neck until multiple nerve trunks are found between the anterior and middle scalene muscles, as seen above. At this level, the brachial plexus typically lies at a depth of 1-3 cm and is found lateral to the carotid artery and deep to the prevertebral fascia, superficial cervical plexus and sternocleidomastoid muscle. You may also be able to see the first rib and/or apex of the lung depending on the depth and level of the transducer.

Other References

  1. National Institute for Clinical Excellence. Technology Appraisal Guidance No. 49. Guidance on the use of ultrasound locating devices for placing central venous catheters; 2002. Accessed 5/28/15. Link
  2. Ultrasound-Guided Interscalene Brachial Plexus Block, NYSORA. Accessed 5/28/15. Link