Central venous access: anatomy and ultrasound
BMJ 2006; 333 doi: https://doi.org/10.1136/sbmj.0611406 (Published 01 November 2006) Cite this as: BMJ 2006;333:0611406
- Alexander Davey, medical student on summer studentship1,
- Christopher Boyd, consultant radiologist1
- 1Department of Anatomy, Queen's University, Belfast
- 2Belfast City Hospital
As a simulated patient in a recent course on ultrasound guided central venous access I learnt the basics of gross and surface anatomy of the venous system; the use of ultrasound imaging to view blood vessels; and the use of ultrasound guidance for venepuncture and insertion of central venous and peripherally inserted central catheters. This quiz covers gross, surface, and ultrasound anatomy of the internal jugular vein with regard to central venous access.
Consider the clinical scenario of a patient who has recurrent deep vein thrombosis and cannot receive oral anticoagulants. The patient will need central venous access to place a filter in the inferior vena cava to prevent pulmonary embolism.
Questions
(1) Where would you find the internal jugular vein, and what are the main relations to avoid?
(2) What features distinguish a vein from an artery in an ultrasound image?
(3) How can you tell that a vein is being punctured by a needle in an ultrasound image?
Answers
(1) The internal jugular vein runs in the carotid triangle then deep to the sternocleidomastoid and the sternoclavicular joint. The internal or common carotid artery and vagus nerve accompany this vessel in the carotid sheath and are at risk of damage. If attempting puncture low in the neck, the lung and subclavian artery are also at risk.
(2) A vein is non-pulsatile, compressible, and increases in diameter on valsalva manouvre.
(3) When a needle impinges on a vein its wall will become deformed in the real time ultrasound image.
Introduction
Central veins, such as the superior vena cava and inferior vena cava are accessed through major veins in the anterior triangle, axilla, and femoral triangle. The target vessels in these areas are the femoral, axillary, subclavian, and internal jugular veins. Access to central veins is necessary for many purposes, such as haemodialysis, …
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