Ultrasonographic comparison of two landmarks for the internal jugular vein: high versus conventional approach

We assessed and compared two landmarks (conventional vs. high approach) used in internal jugular vein (IJV) cannulation with respect to the degree of overlap with the carotid artery (CA) and the cross-sectional area (CSA) of the IJV using ultrasonography.

Forty-eight adult patients were included. Using ultrasonography, the percentage overlaps with the CA and the CSA of both IJVs were measured in the supine and Trendelenburg positions using conventional and high approaches. With the conventional approach, the IJV is penetrated at the apex of Sedillot's triangle, formed by the clavicle and the sternal and clavicular heads of the sternocleidomastoid muscle. The high approach involves the midpoint between the sternal notch and the mastoid process.

The degree of overlap with the CA was 30.5 (7.5-69.4)% [median (interquartile range)] and 0.0 (0.0-25.4)% with the conventional and high approaches, respectively, for the right IJV (P<0.001) in the Trendelenburg position with 30° head rotation. The CSA of the right IJV was 1.22 (0.92-2.01) and 0.98 (0.79-1.72) cm with the conventional and high approaches, respectively (P<0.001), in the Trendelenburg position with 30° head rotation. IJV was more deeply positioned using the high approach than the conventional approach (P<0.001).

The high approach for IJV cannulation decreased both the degree of overlap with the CA and CSA of the IJV and increased the depth of the IJV from the skin compared with the conventional approach.