Utility of the clavicle as a new anatomical target of internal jugular vein catheterization

Yoo, Jong Hoon; Lee, Sang Hun

Abstract

OBJECTIVE
The ipsilateral nipple has been used as a directional guide for the insertion of a conventional central venous catheter via the internal jugular vein (IJV). However, the nipple is not an ideal marker since the position of the nipple varies among the characteristics of patients. The utility of the clavicle was investigated for IJV catheterization instead of the ipsilateral nipple through cadaver dissection.
METHODS
A total of 14 cadavers were dissected (six fresh cadavers, eight fixed cadavers). Each cadaver was kept in its supine position, and its head was rotated 30° to the left. Length A was the distance between the jugular notch and the point that the line from the nipple to sternocleidomastoid muscle apex meets the clavicle. Length B was the distance between the jugular notch and the clavicle point that passed the IJV. IJV was cut and its circumference measured at regular intervals.
RESULTS
Lengths A and B were 3.79±0.35 cm (mean±standard deviation) and 3.71±0.32 cm, respectively, and were significantly correlated (r=0.865, P<0.001). The mean circumference of the vessels were measured to be 3.56±1.29 cm in the right IJV and 3.00±1.32 cm in the left IJV with a significant difference (P=0.013).
CONCLUSION
IJV catheterization via the right one, larger than the left one, is appropriate for the first attempt, and we recommend that the needle should be pointed at the clavicle located at a width of two fingers (2nd, 3rd finger average width 1.9 cm) away from the jugular notch.