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| Year : 2014 | Volume
: 60
| Issue : 3 | Page : 350 |
Internal jugular vein medial to carotid artery
TC Anandaswamy, GC Rajappa
Department of Anaesthesiology, MS Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India
| Date of Web Publication | 14-Aug-2014 |
Correspondence Address:
Associate Prof. T C Anandaswamy
Department of Anaesthesiology, MS Ramaiah Medical College and Hospitals, Bangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.138837
How to cite this article:
Anandaswamy T C, Rajappa G C. Internal jugular vein medial to carotid artery. J Postgrad Med 2014;60:350 |
Sir,
Central venous cannulation is a commonly performed procedure in critically ill patients for inotropic support, central venous pressure monitoring, dialysis, and parenteral nutrition. Internal jugular vein is preferred because of low risk of pneumothorax. Anatomical variations play a role in determining the success rate and in the complications associated with internal jugular vein cannulation.
A 70-year-old male with necrotizing fasciitis of right lower limb was scheduled for emergency debridement. His blood pressure on presentation was 74/40 mmHg and he was in septic shock. In order to resuscitate the patient before taking him up for surgery, a central venous access was planned. This patient incidentally had a pacemaker in situ, which was inserted a few years back for his sick sinus syndrome. The pacemaker leads had been sited through his right subclavian vein; hence, a decision was made to get a central venous access through the left internal jugular vein. As it is our institutional practice to get the central venous access under ultrasound guidance, a preliminary scan of the neck was done. This revealed the left internal jugular vein to be medial to the carotid artery instead of being lateral it [[Figure 1]a and b, arrow]. We were successful in cannulating his left internal jugular vein.
The conventional landmark-based technique for internal jugular vein cannulation depends on it being in a position lateral to common carotid artery. Anatomical variation of the position of internal jugular vein is reported in 20-25% of patients. [1] The common variation described by various studies is the internal jugular vein overlying the carotid artery. Internal jugular vein found entirely medial to the carotid artery is a very rare entity. [2],[3] Variable positions of the internal jugular vein with respect to carotid artery predispose to mechanical complications of central venous access. Routine use of sonography increases the chance of successful cannulation and reduces the incidence of complications. Anatomical variations and difficulties in identifying the landmarks are arguments in favor of the use of ultrasound for vascular access.
| :: References | |  |
| 1. | Lorchirachoonkul T, Ti LK, Manohara S, Lye ST, Tan SA, Shen L, et al. Anatomical variations of the internal jugular vein: Implications for successful cannulation and risk of carotid artery puncture. Singapore Med J 2012;53:325-8. 
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| 2. | Maecken T, Marcon C, Bomas S, Zenz M, Grau T. Relationship of the internal jugular vein to the common carotid artery: Implications for ultrasound-guided vascular access. Eur J Anaesthesiol 2011;28:351-5.
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| 3. | Lin BS, Kong CW, Tarng DC, Huang TP, Tang GJ. Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: An ultrasonographic survey in uraemic patients. Nephrol Dial Transplant 1988;13:134-8.
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[Figure 1]
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