A controlled comparison of techniques for locating the internal jugular vein using ultrasonography

Fifteen techniques for localization of the internal jugular vein ( IJV ) were evaluated in each of 25 subjects using ultrasonography to simulate actual cannulation. Ultrasound images were used to determine puncture of the IJV , puncture of the carotid artery (CA), the distance from the skin to the center of the IJV , the width of the IJV lumen, the relationship of the CA to the IJV , and the lateral distance of the IJV from the axis of the sound beam. No technique proved best in successful IJV puncture. Techniques did differ statistically in rates of CA puncture. Techniques using the CA pulse as a landmark had lower CA puncture rates. Rotation of the head, extension of the neck, and breathholding had no influence on IJV cannulation rates. It is concluded that no one technique is clearly superior to the others. Facility with one technique may be more critical to successful cannulation than the technique itself.