Should Sedillot's triangle be used for central venous cannulation? A cadaveric study

Area of Science:

• Anatomy
• Medical Procedures
• Surgical Techniques

Background:

• Central venous access is crucial in perioperative and intensive care.
• The internal jugular vein (IJV) is a common target for central venous cannulation.
• Sedillot's triangle, using sternocleidomastoid muscle landmarks, is a traditional method for IJV localization.

Purpose of the Study:

• To evaluate the anatomical accuracy of Sedillot's triangle for locating the internal jugular vein (IJV).
• To assess the success rate of a central percutaneous approach to the IJV using Sedillot's triangle landmark.

Main Methods:

• Cadaveric dissection of 61 specimens at the University of Cambridge Human Anatomy Centre.
• Measurement of sternocleidomastoid (SCM) muscle anatomy and insertion of a pin at Sedillot's triangle apex.
• Recording the pin's proximity to the IJV in relation to SCM head distance.

Main Results:

• The pin at Sedillot's triangle apex pierced the IJV in only 61.5% of dissections (71.4% right, 52.5% left).
• Significant anatomical variations in SCM were observed, with no gap between heads in 12% of dissections.
• A poor success rate for the central percutaneous approach using Sedillot's triangle was demonstrated.

Conclusions:

• Sedillot's triangle is an unreliable landmark for internal jugular vein cannulation.
• Anatomical variations can compromise the effectiveness of landmark-based IJV localization.
• Ultrasound guidance combined with anatomical landmarks is recommended for safer central venous catheter insertion.