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IJ Cannulation: Confirmation

When placing an internal jugular central line it is essential to confirm intravenous placement of the line. Inadvertent intra-arterial placement can lead to hematoma, stroke, airway compromise and death. Ideally multiple methods should be used to confirm intravenous cannulation. One of the most common methods is by transducing the vessel’s pressure. This is done by using intravenous tubing connected to the introducer needle or catheter as a manometer. A column of blood should be drawn into the tubing and allowed to fall. A column of blood that does not fall or is pulsatile indicates intra-arterial placement. If manometry indicates intra-venous placement of the catheter the manometer tubing can be removed and the guidewire inserted through the catheter. Ultrasound can again be used to visualize the guidewire within the lumen of the internal jugular vein. Color and PaO2 of the blood from the catheter can help indicate correct placement, but these can be misleading and should not be used alone to confirm correct placement. Following placement of the catheter a chest x-ray should be obtained to confirm correct placement.