Jugular

Consider the following:

Preparation

For preparation:

• Sterile setting, drapes, gloves, etc.
• Seldinger cannula of choice
• Sterile sheath for ultrasound probe
• Standard gel within the sheath and sterile gel outside can use catheterization lignocaine
• Set ultrasound to 10mHz linear probe. Ensure adequate depth.
• Sterile drapes and local anaesthetic

Positioning

Position the patient 30 degrees head-down [10], with little neck rotation and no extension [12]. This maximises venous filling, and removes the risk of air embolism.

Procedure

Image 1

Image 2

Image 3

Image 4

Click the images to see larger versions

The procedural technique for the jugular is as follows:

1. Use normal gel inside and sterile gel outside
2. Secure with a sterile band
3. In cross section, find the vein (80% over or lateral to the artery and compressible)
4. Rotate the probe to see the vein in longitudinal section. Check it is still compressible
5. Use a local anaesthetic
6. Introduce the needle through the skin bevel upwards with transducer in either short or long axis (image 1)
7. Watch the needle enter the vein
8. When blood has been obtained, feed in the wire (image 2)
9. Check the wire is being fed caudally
10. Observe progress on the screen
11. Check the wire remains in the lumen (in both short and long axis)
12. Beware of acoustic shadow
13. Feed the cannula over the wire (image 3)
14. Secure the line
15. Check the line position with a chest x-ray (CXR) (image 4)