This is a popular route for the insertion of single-lumen catheter over-needle devices or multiple-lumen central catheters using a Seldinger technique. A sound knowledge of the anatomy is vital. After emerging from the base of the skull posterior to the internal carotid artery, the vein descends through the neck behind and deep to the sternomastoid muscle, gradually moving to the lateral side of the common carotid artery and ultimately lying anterolateral to this vessel. The relationship of the vein to the deep surface of the sternomastoid muscle is the key to understanding the position of the vein in the neck. It joins the subclavian vein behind the first rib to form the innominate vein. In practice, surface markings are not a reliable means of locating the internal jugular vein as its position, particularly in a lateral plane, tends to vary considerably. Therefore the steady increase in the use of imaging techniques using ultrasound during insertion procedure is a wise development. The main advantage of the internal jugular vein as a cannulation site stems from the fact that the blood flow is relatively rapid. Thrombosis is an unusual complication and usually the same site can be used repeatedly. However, there are disadvantages. Experience and a lot of practice is necessary to obtain the best results for the technique. In the conscious patient, the muscle tone in the sternomastoid can make cannulation more difficult and one must always be aware of the possibility of air embolism during the insertion procedure.
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