From the Guidelines
The internal jugular approach for central venous catheter placement is recommended due to its lower risk of pneumothorax compared to the femoral approach and greater patient comfort and mobility compared to the subclavian approach. The internal jugular vein provides a straight, direct path to the superior vena cava with easily identifiable anatomical landmarks, making it technically easier to access than other sites 1. This approach allows for easy ultrasound guidance, significantly reducing complications like arterial puncture or pneumothorax 1. Some of the key advantages of the internal jugular approach include:
- Lower risk of pneumothorax compared to the femoral approach
- Greater patient comfort and mobility compared to the subclavian approach
- Easy ultrasound guidance, reducing complications like arterial puncture or pneumothorax
- Lower infection rates compared to femoral approaches and less risk of thrombosis than subclavian approaches
- Easier site maintenance and dressing changes
- Ability to accommodate larger catheters when needed
- Permits compression in case of bleeding
When performing this procedure, proper patient positioning (Trendelenburg with head turned away from insertion site) and ultrasound guidance are essential to maximize success and minimize complications 1. The internal jugular approach is particularly valuable in patients with coagulopathies or respiratory compromise where other approaches might pose greater risks.
From the Research
Advantages of Internal Jugular Approach for Central Venous Catheter
- The internal jugular approach has several advantages, including:
- Less risk of pneumothorax compared to the subclavian approach, as pneumothorax is a known complication of central venous catheter insertion, particularly with the subclavian vein [ 2 ]
- Greater patient comfort and mobility compared to the femoral approach, although this is not directly supported by the provided evidence
- Good access for transvenous pacing, as the right internal jugular vein is an optimal placement site for temporary cardiac pacing [ 3 ]
- The airway would not be threatened if a hematoma formed, which is a potential complication of internal jugular vein catheterization [ 4 ]
Comparison with Other Approaches
- The internal jugular approach has been compared to the subclavian approach in terms of catheterization time, overall success rate, and complications [ 4 ]
- The subclavian approach shows a higher overall success rate, but a lower first-attempt success rate in adults, and is associated with less hematoma [ 4 ]
- The internal jugular approach has a higher first-attempt success rate in adults, but is associated with a higher risk of hematoma [ 4 ]
Safe Placement of Central Venous Catheters
- A measured approach to safely placing central venous catheters has been developed, which includes inserting the catheter to a depth of 15 cm and obtaining chest radiographs to check tip placement and evaluate for mechanical complications [ 5 ]