From the Research
For internal jugular vein central venous catheter (CVC) insertion, the recommended insertion depth is 15 cm for the right internal jugular vein and 18 cm for the left internal jugular vein, as determined by a prospective cohort study 1. These measurements are taken from the skin entry point to the catheter tip. For more precise placement, the use of formulas such as height (cm) ÷ 10 for right-sided insertion, and add 2-4 cm for left-sided insertion, may not be as accurate as previously thought, as a study found that a formula-based approach was less accurate than using a recommended depth of 15 cm for the right internal jugular vein and 18 cm for the left internal jugular vein 1. After insertion, always confirm proper positioning with a chest X-ray before using the catheter for infusions or measurements. The goal is to position the catheter tip in the superior vena cava, just above the right atrium junction. Inserting too deeply risks cardiac arrhythmias or perforation, while insufficient insertion may lead to malposition outside the central venous system. Patient factors like height, body habitus, and anatomical variations can affect optimal insertion depth, so clinical judgment should be used alongside these guidelines. If resistance is met during insertion, never force the catheter as this could cause vascular damage. Additionally, the use of ultrasound guidance for internal jugular vein cannulation has been shown to reduce the rate of mechanical, infectious, and thrombotic complications by 57% and reduce the failure rate by 86% 2. A more recent study also found that ultrasound-guided distal internal jugular vein and axillary vein approaches for central venous catheterization have high success rates and low complication rates 3. However, the most recent and highest quality study on the topic of internal jugular vein CVC insertion length is from 2012, which provides the recommended insertion depths of 15 cm for the right internal jugular vein and 18 cm for the left internal jugular vein 1. Key points to consider when performing internal jugular vein CVC insertion include:
- Using a recommended insertion depth of 15 cm for the right internal jugular vein and 18 cm for the left internal jugular vein
- Confirming proper positioning with a chest X-ray before using the catheter
- Using ultrasound guidance to reduce complications and improve success rates
- Avoiding forcing the catheter if resistance is met during insertion
- Considering patient factors such as height, body habitus, and anatomical variations when determining optimal insertion depth.